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Application <br />- FOR - <br />Cedif <br />. iCate of AppropHateness <br />Historic Preservation Commission of South Bend & St Joseph County: <br />125 S. Lafayette Blvd, South Bend, Indiana 46601 <br />Mailing "Arpm* County-CityBuilding, SouthBend, T__1 <br />iarrta 4601 <br />Phot: 574-235-M 9 Fax:57-1-235-%78 I Email:-SBSj01PMD.st-joscphirLuS <br />Website. httly//www.stjoscplicountyindiam,com/., chp/indexhtmI <br />OFFICE USE ONLY>>>>2,> DO NOT COWLM ANY ENTRIES CONMINED IN THIS BOX >>>>» OFFICE USE ONLY <br />Date Received')-.') .10 Application Numberz— — — — <br />Past Reviews: % YES E]NO <br />Staff Approval authorized by: <br />Historic Commission Review Date- A�IJ,10 <br />Local Landmark Local Historic District (Name) <br />National Landmark National Register District (Name) <br />Title: <br />Certificate of Appropriateness - <br />Denied [_] Tabled F1 Sent To Committee n Approved and Issued <br />DATE <br />Address of Property for proposed work: Rozlde_ Ave_- <br />Itreet Number and Street Name <br />Name of Property Owner(s); (Please Print)( -Ttlti'Vt (1virto.01. <br />Address of Property Owner(s): <br />Contractor(s) Name: <br />Contract Company Name: <br />Contractor Address: » S' M_ Ott ICAA/ku <br />City- R. Phone: <br />Current Use of Building: f, a <br />le Family - Mult4a mily - Commerci4l - Government - industrial - Vacant - etc.) <br />Type of Building Construction: <br />(Wwd Frame - Brid - Sttme - Steel - Conaefe - other) <br />Proposed Work: [] In-kind ] Landscape E] New E] Replacement (not in-kind) E] Demolition <br />(more than one bor may be chxW) <br />Description of Proposed Work: C e tl,c e %.*t 01 IQ I., r e 4 'C It -t Aa (.L_ <br />ty* t"4441 Arle'rit^ '10D <br />Ourner/Contractor. Fax: e-mail ±G _%j r CkVQ <br />(7mus offi(MV foll cens *rid with only one desiptee) <br />and/or <br />3—�APPIUICA710N REQLHMWNIS ARE LISTED ON RLITRSE SIDE — <br />