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Application <br />- FOR - <br />Certi <br />fiCate of Appro ptiateness <br />Historic Preservation Commission of South Bend & St Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />Mailing Address: County -City Bingc_&L ii—A T -A.— AfAll <br />Phone- 574-235-97% - F= 574-235-9578 - Email: SB5JCHPC@cost­j0sephirLus <br />Website: http://wwwsqosephmntyindiana.com/sjchp/ffidoLhtnl <br />OFFICE USE ONLY>>>>>> DO NOT COMPLETE ANY ENTRIES CONABUD DV THIS BOX >>>>>> OMCE USE ONLY <br />Date Received 4,Sde-7--21110 Application Number aim —/10— - /,0 I�r <br />Past Reviews: BI�ES(Da qLastm4.) [:] NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: <br />aLocal Landmark E] Local Historic District (Name) <br />F1 National Landmark [] National Register District (Name) <br />Certificate of Appropriateness: <br />[Denled [] Tabled []Sent lb Committee Approved and Issued 1504,7-27610 <br />DATE <br />Address of Property for proposed work: h /,//,i o yor,' P� A 01--, <br />Strert NumW4nd StMft NOW <br />< - po <: <br />Name of Property Owner(s): (Please Print) <br />Address of Property Owner(s): <br />Contractor(s)Name: ^X'4m" "qx _-rr' <br />Contract Company Name: <br />Contractor Address- <br />city - <br />Current Use of Building: --S- <br />(Single Family -Multi-Family - Commmial - Government -industrial - Vacant -tic.) <br />Type of Building Construction: 1')r'1( -"R1 <br />(Wood Frame - thick - Stone - Sted - Concrete - Other) <br />Proposed Work- [-] In-kind q Landscape New [ Replacement (not in-kind) E] Demolition <br />(mm than me b= may be d=W) <br />Description o f Proposed Wo rk: ft IA k, ;; TA 4 ' <br />7;o <br />Owner/Contractor e-mail AIS A-V^ (-�<//3c` a C , /"In-, 1,0, a� <br />(This office u0 w=jvnd with only one dmigw) <br />and/or <br />• <br />