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Application <br />- FOR - <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Rend & St. Joseph County <br />125 S. Lafayette BIvd., South Bend, Indiana 46601 <br />Mailing Address: C.r�unry-City Building, South Bend, Indiana 466(}1 <br />Phone: 574-235-8748 • F=574-235-9578 - EmaiL-SBSJCBPC@m-st-josePtLin.us <br />Webslkt http://wwwstjosephcountyindLu-moom/ichp/index html <br />OFFICE USE ONLY >>>>>> DO NOT COMPLETE ANY ENTRIES CONIVNED IN THIS BOX :»»» OFFICE USE ONLY <br />Date Received 16 Orr. aW 10 Application Number <br />Past Reviews: aYES (cauoflOtML.a) n NO <br />Staff Approval authorized by: / 't Title: •.{, 11;b <br />Historic Commission Review Date: <br />0311ocal Landmark n Local Historic District (Name) <br />National Landmark E] National Register District Wayne) <br />Certificate of Appropriateness: <br />�] Denied [] Tabled E] Sent To Committee Q'Approved and Issued 2" <br />DATE <br />Address of Property for proposed work: - 1 <br />Street umber and Street Aflame <br />Name of Property Owner(s): (Pl..Print) /'4,Ar_ <br />Address of Property Owner(s): <br />Contractor(s) Name: <br />Contract Company Name: <br />Contractor Address: - <br />City: r� /Z % /--. f l/ Phone: t '1�� 5 Z) <br />Current Use of Building. <br />(Single Family — Multi -Family — Commercial — Gmrrnment —Industrial —Vacant — etc.) <br />Type of Building Construction: <br />(Wood Framt — Brick —Slane —Steel — Concrete —Other) <br />Proposed Work: may <br />n -kind n Landscape n New ; Replacement (not in-kind) ❑ Demolition <br />(more than one box may be drecker!} <br />Description of Proposed Work: &1e,�i14 <br />t F 7"r) i f �, %.ar- }a iii+ x"- <br />r1�i' .'� ��✓ .fir%.: � A y'.' 7 � asd.r•,_t " `'- .,l i �.w . _ t•1 ,f �'''J'.S' .%/r..1 «; <br />OwnerlContractor: Fax � '� $? `i 5. ,e4 "7 <br />(T}aisoffice wig rvmsptmdWit; uh,Ianedmignre) <br />.. <br />-. �'"..-_°'....•.�.'�„�'' �-�.--..r....-�"'.--- �".---• and/or <br />e-mail /?'S2 >.�,nr� ;yamr"%� �' r's�" x1449, /'t;, U-5 <br />j <br />• <br />