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Application <br />FOR - <br />Ceiti f icate of Appropriateness . . <br />Historic Preservation Commission of South Bend & St Joseph County <br />• . 125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />Mailing Addt+ess: Countj►-City Bwlding, South Bend, Indiana 46601 <br />Phony 574-2354M • Fac 57425.9M • Emaib cwwj�'=%_.bbp:st-jO®eph3aus <br />Webaite: h*//wwws wThmuntyindiarw=/*bp/indexhbrJ . <br />OFFICE USE ONLY»»» DO NOT COMPLETE ANY ENTRIES CONnn= IN THIS BOX »»» OFFICE. USE ONLY <br />Date Received. 'i�=�-� Application Number <br />Pest Reviews: [R4'M (Oeta•ffaettr kw) !/- .%9 =e1" 9 [].NO <br />Staff Approval authorized by: <br />TItle: <br />Historic Commission Review Date: M) <br />F1 Local landmark [ fAcal Historic District (vane) ip•���y e� A <br />❑ National Landmark ' ❑ National Register District (vane) <br />Certificate of Appropriateness: <br />❑ Denied ❑ lhbled '❑ Sent lb Committee ❑ Approved and Issued <br />Dors <br />Address of Property for proposed work I lX t:::- VJA1 'V <br />S� ianberand Stmt Name <br />Name of Property Owner(s): (Fkm Print) A 11 �T/I n % dry <br />Address of Property Owner(s): _EAW 2 _ <br />Contractor(s) Name: nn t'M <br />Contract Company Name: WAY) <br />l i/� AY) r1 % l �✓ <br />Contractord <br />i I� 11► Phone: <br />Current Use of Building- 1 <br />ngle roily -Multi -Family- nteraal-Covernntent-Industrial-Vacant-edc.) <br />Type of Building Construction: <br />(Wood Franre— Brid<— Stone— Steel—CO U7de— Other) <br />Proposed Work' O In-kind ❑ Landscape ❑ New ❑ Replacement (not in kfnd) ❑ Demolition <br />(more than are boa: mry be d�edbell <br />Descrintion of Pronosed Work _ . <br />Owner/Contnictor. Fax e-mail <br />(Thio Wor=71 mmqwd with adyon*dV=). <br />and/or <br />APPLICATION REQWRE11MM ARE LISTED ON REVERSE SIDE — <br />