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Application <br />- <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46W1 <br />Mailing AAA—r— Building, South Bend, Indiana 4Gb()1 <br />Phone: 5744-235-97'98 • Fax: 574-235-%78 • Email- SBSJO PMo.st-josephinus <br />Website. littp://www.stjoscphcountyituiiana.com/sjchp/index,htm! <br />OFFICE USE ONLY>»»> DO NOT COMPLETE ANY ENTRIES CONVIINED IN <br />THIS BOX >>>>>> OFFICE USE ONLY <br />Date Received /`%/o Application Number - l�IKif� <br />Past Reviews (1 YES (IMteo/Ix,tReu;eQ n NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: % 7 >;(44 f -Wrt� <br />Local Landmark Local Historic District (Name) <br />F1 National Landmark E] National Register District Wane) <br />Certificate of Appropriateness: <br />Denied n Tabled [) Sent To Committee (❑ Approved and Issued <br />Dnrr. <br />Address of Property for proposed work: V <br />Str, eWumber and Street Naple <br />Name of Property Owner(s): (Please Print) S C :.��,._; <br />Address of Property Owner(s): 7 �Ltla.. o Ste' <br />Contractor(s) Name: <br />Contract Company Name: <br />Contractor Address: I �'?6`�'t (2A— <br />City: Q 4W . Phone: <br />Current Use of Building <br />(Single Family MultiFamiI - Commercial - Cenernment- Industrial - Vacant - etc.) <br />'Type of Building Construction: <br />(Wood Frame - Brick- -Stone -Steel - Concretr -other) <br />Proposed Work: ❑ In-kind ❑ Landscape <br />(more than one bore nrry be dwded) Ldj <br />Descri tion of Proposed Work: <br />VX- �' <br />k i+\ CA - <br />MNe}w] �}❑ Replacement (not in-kind) F] Demolition <br />K"r�c� <br />' ) (Aj 1 <br />Owner/ ontractor. Fax: e-mail <br />(M. %, i W171 car tGni bnlyone desigum) <br />and/or <br />t <br />vi1►'- <br />1�v�.. tJ t r�Ct� y�✓.k13%r✓o� <br />— APPLICATION REQUIRDWEN TS ARE LISTED ON REVERSE SIDE -- <br />