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Application <br />- FOR - <br />Certi. f irate of Appropriateness <br />Historic Preservation Commission of South Bend & SG Joseph County <br />125 S. Lafayette Blvd., South Band, Indiana 46601 <br />Mailing Address: County -City Building, South Bend, Indiana 46601 <br />Phone: 574-M9798 • Fax: 574235-9578 • Email SBSJCHPC@eo.st-0sephinus <br />Website http://ivwsv.sgosephcountyindiana.com/schp/index.litml <br />OFFICE USE ONLY»»» DO NOT COINPLETE ANYENTRIES COIMINED IN TRIS BOX """OFFICE USE ONLY <br />Date Received ofg O 11- c1010 Application Number _2�0 /D - -0 q t <br />Past Reviews: n YES (NLeafustptevirto) ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: /7 MIr AP A0 <br />[B.ocal Landmark Local Historic District (Nara:) <br />[� National Landmark National Register District Wow) <br />Certificate of Appropriateness: <br />[] Denied [] Tabled ❑ Sent To Committee ❑ Approved and Issued <br />Address of Property for proposed work: .5/4 MS67- .L.4 S4L _,- <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) CONN/E rrrr %_-oAe 10.04eY <br />Address of Property Owner(s): '1.5;z d4/457"__ /_ I's4 4L_,r <br />Contractor(s) Name: r%AS/tfU/i ,c{!LL <br />Contract Company Name: l' . C d S SGT'-/C71t1 -r' , ck3 FJ.Ae G <br />Contractor Address: .'S �. /�', / •� i l 4 %7'V6 <br />DATE <br />es2oi� —e, 7(7 Z. <br />City: 4;6C_C4 L ,l9 4,561 Phone: l 74t - 4122- 6 <br />Current Use of Building: SW4 L�C FWAI'14 y (:1C_ ..: ,oj'So 7 / <br />(Single Family - Multi -Family - Commercial - Government - Industrial - Vacant - etc.) <br />Type of Building Construction: Fe41Y6 <br />( Wood Fra me - Brick - Stone - Steel - Concrete - 09ter) <br />Proposed Work: ❑ In-kind _[:] Landscape [] New replacement (not in kind) E] Demolition <br />(more th4n one, Itis dray be checked) <br />Description of Proposed Work: COHd9'L,67-e 76A,e". -®FF' e c ,i'ara. 11v, NRrF..e�o�.e. . . Af/.IF7J <br />�,��L�3C E �e�cr�.4,5 �1'et7'��,$.�'d?3"` iN.'i'7",9G� T:•,G-l/,,LtTX'.,r" �,r//��,p,, frtr.�,�l <br />+PE+°!r<A4' CH/•eI�IEY f7S JY EDs.�%. PFYCVJ.VT hllr# 1./MF PU77Y� I-40,e7W-e- <br />Owner/Contractor: Fax: e-mail <br />m{requndi 'th one } <br />Xand/or <br />-- APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />