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Application <br />- FOR - <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />Mailing Address: County -City nuilding, South Bend, Indiana 46601 <br />Phone: 574235-9798 • Fax: 574235-9578 Email: SBSJCHPC@co.stjoseph.in.us <br />Website htiV://www.sqosephcounqindiana.'com/s chp/index.html <br />OFFICE USE ONLY»»» DO NOT COMPLETE ANYENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received /D 27f&t 94 Application Number <br />Past Reviews: E] YES (Date of Lot Review) <br />Staff Approval authorized by: <br />['i • <br />Title: xa... z. - + <br />Historic Commission Review Date; <br />[] Local Landmark lJ' Low Historic District (Name) <br />[National Landmark F1 National Register District (Name) <br />Certificate of Appropriateness: <br />E] Denied ❑ Tabled n Sent To Committee [ pproved and Issued <br />DATE <br />Address of Property for proposed work: 'D I` "t" P (S (a_ ,�_ _R <br />Street Number and Street Name <br />Name of Property Owners}; (Please Print) i A 1 <br />Address of Property Owne,r,(s): (` f. S <br />Contractor(s) Name: !t' L iFl <br />c <br />Contract Company Name: r I <br />Contractor Address: 76 <br />-3 .4-l" o t1 S� t�`� 40 if, , <br />City: Q7 , Phone: -y�C .. �L� -Ocs-L <br />Current Use of Building: <�!t. � f -`4-941x` IV <br />(Single FF•amily — M lti-Family — Commerda! — Government —industrial — Vacant— etc.) <br />Type of Building Construction: <br />(Wood Frame Bridc — Stone — Steel — Concrete — Other) <br />Proposed Work: n -kind Landscape ❑ New [, Replacement (notin-kind) E] Demolition <br />(more than onebox may be checked) <br />Description of Proposed Work <br />ej <br />Owner/Contractor. Fax: e-mail `J <br />(This oIce wal c orreyond will my one designee) <br />��1Z and/or <br />— APPLICATION REQU%REMENTS ARE LISTED ON REVERSE SIDE — <br />