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Application <br />FOR - <br />Certificate a, f Appropnateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Lrdayette Blvd., South Bend, Indiana 46601 <br />Mailing Address: County -City Building, South Band, Indiama 46601 <br />Phony.: 571-235-9798 • Fax: 574-235-9578 + Email: SBSJCHPC@7co.st joseph inus <br />Websitt- http //�vww.stjoR!pluountyindiana.coni/sjchp/in(ic.x.htmi <br />OFFICE USE ONLY»»» DO NOT COMPLETE ANY EAURIL'S COAMINED IN THIS BOX. »»» OFFICE USE ONLY <br />Date Received ?x&t' Z aZ'0/0 - Application Number!�� Id - t7.30 <br />Past Reviews: [ YES (Nie of test )Zmew) ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Corrnnission Review Date: <br />(� Local Landmark g': cal Historic District (Nunn) 5 w� <br />❑ National Landmark E) National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied n Tabled n Sent To Committee 0 Approved and Issued <br />t3nrr. <br />J <br />Address of Property for proposed work: <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print)_— <br />Address of Property Owner(s): : ) -7 { lc V . t i ' ' 55,i <br />Contractor(s) Name: .--Aso( 0"4xP_I C_o <br />Contract Company Name: _jv ho u'l) {- <br />Contractor Address: x-7`71 j, C --rte- t t�� J-2- -rt- Z. <br />City: VA'i , < V4-%4. -,A) %Or 14 %d.. _. Phone: <br />Current Use of Building: ` t taJ t.rk=LAA t t <br />(Sirrglr. Family - Aluiti-Family - Commercial - Gmernment - tndustriai - vacant- etc.) <br />Type of Building Construction: A) 13 of> <br />(Wood Frame - Brick - Stone - Steel - Concrete - Other) <br />Proposed Work: � In-kind ❑ Landscape ❑ New ❑ Replacement (not in-kind) E] Demolition <br />(more than one box troy he chmtrci) <br />Description of Proposed k%brk: ?__=j2L-W I-- r= AA ±( �- <br />�.c-t +2_1ii� kw <br />Owner/Contractor. Fax: e-mail <br />(This (flim u171 curresrm"hd with only one <br />�".-........... ...... and/or _.:......._ ....... _.......... ........ __......_.....__..._._._..._.__...__.._.... _.._...._,._...__...:..........._ __._............._ <br />-- API-ILICA77ON REQUIRF.AIENTS ARE LISTED ON REVERSE SIDE -- <br />