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Application <br />- FOR - <br />Cedificate of Appraptiateness <br />Historic Preservation Commission of South fiend & SL Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />Mailing Address. County -City nuilding, South need, I_A-"� 46fi(l1 <br />Phots 574-235-97% • Fax: 574-235-9578 • Email SBSJCHPC@co.st josCPhin.us <br />Website http://www.sgoscphcounlyindiarkacom/sjchp/index,html <br />OFFICE USE ONLY>>»y> DO NOT COMPLETE ANYEMIES CONMINED IN :CHIS BOX »»» OFFICE USE ONLY <br />Date Received c>to I0 Application Number <br />4010 - 4Sor3- 1 <br />Past Reviews: ©°YES (Date oftustReview) f' n44 -t.-! .7-O'.tS [] NO <br />Staff Approval authorized by: Title: <br />�r.�rG -o �a3-t <br />Historic Commission Review Date: <br />Fj Local Landmark [Local Historic District (Name) <br />[j National Landmark [] National Register District (Namr) <br />Certificate of Appropriateness: <br />Ej Denied [] Tabled [] Sent To Committee Approved and Issued <br />DATE <br />Address of Property for proposed work: - 6 /, ` ", -,� < <br />ffStreet Nurttber an street Na e <br />Name of Property Owner(s): (Pleze Print) �4"er / -e /_-_1 A <br />Address of Property Owner(,): <br />Contractors) Name: C, <br />Contract Company Name: / - PR 0 <br />Contractor Address:� <br />City: 5,0, r>e, nr Phone: <br />Current Use of Building: P <br />(Single Family - Multi -Family- Commercial - C.,o*.wnment - Industrial - Vaunt - rtc.) <br />lrpe of Building Construction: <br />(Woad Frame - tirid - stone - Steel - Conacte - Other) <br />Proposed Work: I J `In-kind [❑ Landscape ❑ New ❑ Replacement (not in-kind) [] Demolition <br />(more than one box may be dwrkrd) J f �} / <br />�e sx YW I' j,C'e- t- r r:.' <br />Description of Proposed th�k: �-l` ,�/ <br />QAJ�jC, C'G:.7rt3lLt . tSL' 7fLl^'T jTd°} A %e F e10/4re*.1 <br />G. C N.C. j- e 1-e t-* f i� bt dT v et -S <br />OwnerlContractor. e-mail <br />(This njj`ue rural ��rnrd ymtedesi n - - <br />and/or _._._....___ __._._..._._. <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE. SIDE -- <br />