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Application <br />- FOR - <br />erti fiCate of Approptiate ess <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 4001 <br />Mailing Address: County City But7ding, South Berm, Indiana A4=1 <br />Phone -.574-235-9M - Fax574-235-9578. - EmA- SBSJCHPC@cost *ephin us <br />Website: http://wwwsgowphcounq indLv a =/Ochp/indexbW <br />OFFICE USE ONLY »»» D0 NOT COMPLETE ANY ENTRIES CONWIED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received 01I dGr- -761r© Application Number C9410 . /OZ/ <br />Past Reviews: DYES (gate of last hwkw) <br />Staff Approval authorized by: <br />Historic Commission Review Date: <br />E16cal Landmark Local Historic District (Name) <br />[] National Landmark National Register District (Name) <br />[] NO <br />Certificate of Appropriateness: <br />(3 Denied [] Tabled E] Sent To Committee ElIpproved and Issued 4100r.W le) <br />DATE <br />Address of Property for proposed work:;Z/ t telex <br />i Stmt Number and street Name <br />Name of Property Owner(s): (Phase Print) 1 P r i rlo t,, n vin- ,n 9, t c Z,-. <br />Address of Property Owner(s): "7 t I J Sn Yti r) Y--) <br />Contractor(s) Name: <br />Contract Company Name: V, l a J Y' t r <br />Contractor Address: <br />City: Phone: <br />Current Use of Building: --L,6 Y.,— e.Ar-~ : e-\� <br />(Single Family — Multi -Family — Commereial — Government —Industrial — Vacant — etc.) <br />Type of Building Construction: <br />( WOW Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: Bo -kind [] Landscape [] New ❑ RepIacement (not in-kind) ❑ Demolition <br />(more than one box msy be drecW) <br />Description of Proposed Work: c, K:�. +Ci �iC <br />Owner/Contractor: Fax: - <br />('lius mice Milt cvrrespv d wi one des' etre) <br />and/or <br />e-mail <br />y <br />