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Application <br />-FOR - <br />Certi icate o, f Appropriateness <br />Historic Preservation Commission of South fiend & St, Joseph County <br />125 S. Lafayette Blvd., South Knd, Indiana 46601 <br />Mailing Address Cnunty-City Building, South Bend, Indiana 46601 <br />Phone: 574-235-9798 - Fax: 574-235-9578 - Email: Sl1,SJC11PC@co.st josephiaus <br />Website http://ivww.stjosepheountyindiamcc)m/Ichp/index.html <br />OFFICE USE ONLY »»» DO NOT C »»» OFFICE USE COMPLETE ANY ENTRIES COMI?t}TdID IN 7Ti15 BOX E ONLY <br />Date Received 44 Application Number'4 <br />Past Reviews: [94S (N"a 'll.txk.) e .Z -?-0O 7 ❑ NO <br />Staff Approval authorized by: <br />Title: <br />Historic Commission Review Date: '17 79&/ lt4 l a <br />n Local Landmark 0 'focal Historic District (Name) G ea <br />n National Landmark [] National Register District (Name) <br />Certificate of Appropriateness: <br />[) Denied [] Tabled Sent Th Committee ❑ Approved and Issued <br />pAT1s <br />Address of Property for proposed work: f 7 <br />_ Stntt � � / Stmt Nu Brand Name,Name of Property Owner(s): (Please Print) %p f- b`-' z <br />Address of Property Owner(s): % 7 / 44 <br />Contractor(s) Name: <br />Contract Company Name: <br />Contractor Address: 9z' <br />City: M j.� i� Phone: <br />Current Use of Building: <br />(Single Family — Multi_Fa milt' — Commercial — Groernment — Industrial — l'arrnt — etc.) <br />Type of Building Construction:1 G' <br />( Wood frame — Brim — Stone — Stwl— Concrete — Crfher) <br />Proposed Work: �In-kind D Landscape ❑ New ❑ Replacement (not in-kind) [] Demolition <br />(mme tlon one box nay be chr d) <br />Description of Proposed Work: AlE GLIA VT— 70 t 4C,E 72_� <br />W111J00W S 7W7- .A,P2 AW O/L ' /2 c4114 17'� 1 n� 0 t/h'. ,t�MF I,rJi 7�-J <br />/9�A (S'459 M ea7- tA.1I 1-jvo /-j 5 . 'TlZ-j-0 w u.-)5 6 Tem r� <br />1 , G454F1j7_ 1,1/ Xf,4A- 1,115 ivoVL.tp L)!4( 7D 12<P64C46 W r7N D . <br />Z�- e-mail .J .1 BPA�Y C Z !' !Qty 1. - Cc,ft-A <br />Owner/Contractor: Far. " <br />(IT%s offI unit mr . with o tyonerlesignee} _ <br />and/or <br />— APPLICATION REQUIREMENTS ARE L1 TED ON REVERSE SIDE — <br />