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Application <br />-FOR-. <br />Certificate of Appropfiateness <br />Historic Preservation Commission of South Bend & St Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />MM11no Arlrfracs— County-CityBuilding, C__3 <br />14 Bend, T_ <br />Phorv--574-M5-9798 * Fax: 5741235-9,578 * Email: SB5JCHPC@c:ost-j0sephinus <br />"lebsitLt http://Www.stjowphcxnmqindiana,com/*hp/index.htinl <br />OMCE USE ONLY>>>>>> DO NOT COMPLETE ANY ENTRIES CONI UNIED INTHIS BOX >>>>>> OMCE USE ONLY <br />Date Received 41 AFkJL- .2010 Application Number _!9_0PL - d 'Afxfi <br />Past Reviews. F 1' S (021tafl-Mmiew) '7-/'3 --Zoo 7 E] NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: 7 ?7e -qt d20/ 0 <br />C/? / <br />Local Landmark ['Local Historic District Qvamr) <br />National Landmark - [; <br />fNational Register District ovano <br />Certificate of Appropriateness: <br />Denied n Tabled E] Sent To Committee E] Approved and Issued <br />DATE <br />Address of Property for proposed work: OU <br />St Number and Street MI'l <br />Name of Property Owner(s): (pims, print)kox4jlf <br />Address of Property Owner(s): <br />Contractor(s) Name: <br />Contract Company Name: <br />Contractor Address: <br />City: Phone: <br />Current Use of Building. t1k 1'r, (:b " 1'�, 6e <br />(Single Family- Mut-Famity- 6mmerciff -GmPerninent - Industrial - Vacant - efcJ <br />Type of Building Construction: I A i) <br />f(Wwd Frame - Brick - Stone- Steel-Concreir- Other) <br />Proposed Work: 0 In-kind Ej Landscape 0 New F1 Replacement (not in-kind) F1 Demolition <br />(mare than ore ba nvy be dr -W) <br />Description otProposed Work: .9, xk�' /40 e. Ate' as tieifi, e7� t� <br />t.. .. ......... ... <br />Owner/Contractor Fax; e-mail <br />(This qrlm Idth Vnly one designet) <br />----- - - and/or <br />x <br />4?q <br />-- APPLICATION REQUIMMEAMS ARE LISMD ON REVERSE SIDE — <br />