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Application <br />- FOR - <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />Mailing Addmss: CountyCity Building, South Bend, lndiaik� 466))1 <br />Phone: 574-135-9798 • Fax; 574.235-9578 - Fanail: SBSJCHI'C(C�rn.st-j(y eph.in.i.t~5 <br />I'Vebsite:,,ti,i%•tvstjosephcotuttyiiidiana.com/si lip/indox.html <br />A Certified Local Government <br />OFFICE [ISE ONLY »»» DO NOT COMPLETE ANY I:ilTjUEY,S hrAINFD IN THIS BOX »»» OFFICE USE ONLY <br />Date Received ..ZO/O Application Number <br />Past Reviews: ErYES (Lmteof tnstR ictn) ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: l % 2X -2010 <br />(+� Local Landmark [B<ocal Historic District (Name) <br />[:] National Landmark [ ational Register District (Name) <br />Certificate of Appropriateness: <br />[:) Denied E] Tabled C] Sent To Committee R Approved and Issued <br />DATE <br />Address of Property for proposed work: �>a4e-L 4vp— <br />Name of Property Owner(s): (Plrasc• Print) t,) <br />Address of Property Owner(s): 6a-'rtQ Ax, d ve_- <br />Contractor(s) Name: J / <br />Contract Company Name: g Cx- - AV cel t j7C <br />Contractor Address:ArML <br />Current Use of Building: -S i�vEgle <br />. t'�i'.�wl lq S i d600 Phone: t '. <br />Ta.mitY Alulti- anvil y - Commercial - Government - Industria? - Vacant -etc.) <br />Type of Building Construction: 0 0 -j�iY\4C_ <br />(Word frame - Brick - Stone - Steel - Concrete- Other) <br />Proposed Work: In-kind F� Landscape X New F� Replacement (not in-kind) ❑ Demolition <br />(mare thv: nrte box may Iv ehoded) <br />Description of Proposed Work: <br />OwnerContr CIO' <br />F t e-mail ` U�✓ � .. 9 ;tiro t. O <br />(This off" a will co esP d unit t I one designee) <br />_ <br />and/or <br />Si tf Ht%rre✓�_ 5irtrttttrr of Contractor _ <br />— APPLICAVON REQUIREMrNTS ARE LISMD ON REVERSE SIDE — <br />