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Application <br />-FOR- <br />C'erti'ficate 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 Buflding, South Bend, Indiana 44601 <br />Phone: 574-235-9M • Fax: 574-235-95713 • Email: SB5JCH1'C@co.st joseph.in.us <br />Website: http://%vwws# osephcountyindianacom/s chp/index,htmI <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX »»>> OFFICE USE ONLY <br />Date Received l,? fit' -4k., -Z 4016 /� Application Number �,0f ©- 4,V1 2- <br />Past Reviews: y YES (Date of fast Rrriew)IM5 --U If 111A- [] NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: <br />[] Local Landmark cal Historic District (Name) <br />k <br />National Landmark n National Register District (Name) <br />Certificate of Appropriateness: <br />F] Denied [] Tabled ❑ Sent To Committee [j Approved and Issued <br />DATE <br />Address of Property for proposed work; 3 ! - .�v.+ny1i�� 14vt ilc J 0Lor-vft _771' <br />W <br />%� % % Street Number and Street, Nam <br />Name of Property Owner(s): (Please Print) /i t Cfi't rd i cra<d Va rid v -_r <br />Address of Property Owner(s): Y -r - .V .rnrrt-rrtcr vC <br />Contractor(s) Name: IVA- �;����L _ <br />Contract Company Name: <br />Contractor Address: c� <br />City: �~ t Phone:» 7 - <br />Current Use of Building:h�t�� t�Arst�l <br />(SingleFantily— Multi-Farnify — ConmercW— G nmment — Industrial —Vacant — etc.) <br />Type of Building Construction: I*iP$r�" ilk4 C <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: E] In-kind ® Landscape [] New n Replacement (not in-kind) (] Demolition <br />(more than one ins may be drnked) / % <br />De iption of Propos d Work: w m r 7r,,r, <br />4rx7' cf 1' iVr Wa". !N -0 a7Ji m-r7- <br />�j <br />- 16^7 xAd. Propos <br />7fr4v Wrrr STdt 7'rhrvr c?w.rr Al lr -CSV*Y I V.- <br />UTAJ Q. F S w Y / h> rjr�t lOt7 'r Id ref VJ d tl rd Jr o d Vol <br />INCdNVrrt;r►A 1 /0 -7,1 .r;,,17 ArXT 7`+o � / <br />if r {(r�;tra} ,� t r� 7 6&6 7� r,-7 rrf M <br />'��-�J <br />�canerr ontractor. Fax: S 7 y". t�r t�..7�c� e-mail lS�c vl hit rP /7.. w. ce'n <br />tuill mrmsp and with only one designee) <br />and/or - <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />