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Application <br />- FOR - <br />Certificate of Appro priateiiess <br />I listOric Preservation Commission of South Bend & St. Joseph County <br />125 S. Lafayette Blvd, South BLmd, Indiana 46601 <br />Mailing Address: County -City Building, South Bend, Indian Af-,Al <br />Phone- 574-235-9798 - Fax:574-235-T578 # Email:SBSJCIfPC(a)co,st-jt)cA-ph,ifitis <br />Website: littlY//wivw.stjo,%�phcountyindiami.com/.schl�/inth..,X.IitinI <br />OFFICE DISE ONDO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX OFFICE USE ONLY <br />Date Received � - 'tq I 10 Application Number L 0 1 0 - 0 R F.Y,E-: <br />Past Reviews: ] YES (mt, of Last Rmitw) <br />Staff Approval authorized by: <br />E] NO <br />Title: i' D <br />Historic Commission Review Date: 01- <br />] Local Landmark [� Local Historic District (maw) \v C rBey—)j <br />E) National Landmark f -j National Register District (6vaftw) <br />Certificate of Appropriateness: <br />M Denied [] Tabled Ej Sent To Committee [] Approved and Issued <br />DAfF <br />Address of Property for proposed work: k7+-tt =_K -Sr n;c n <br />Sired Numberand Street Name <br />Name of Property Owner(s): (Plmsr. Print) <br />Address of Property O-wner(s): r /)01- <br />Contractor(s) Name: 11 F r oa, *in -A :5 <br />Contract Company Name - <br />Contractor Address: e42 jk. 1 <br />City: Phone: <br />Current Use of Building: <br />commercial - Qvernmerf - Indititrial - Vacant - rtc-,) <br />Type of Building Construction: (-)rte o - Flz i, m,F <br />Proposed Work- [gIn-kind[] Landscape E] New n Replacement (net in-kimf) E) Demolition <br />(mare Von one ba may be che.ked) <br />Description of Proposed Work: to— Va",e, q plo <br />J <br />4 -&J -D 14 <br />I A-1 A4 tO <br />Ov,mer/Contr c or- \ Fax: e-mail <br />we wall ,p ind with only one designee) <br />and/or <br />1j t <br />J1 APPLICATION REQUIREMEWS ARE LTSTEI) ON REVERSE SIDE -- <br />