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Application <br />- FOR - <br />Certi <br />ficate of Appropriateness <br />Historic Preservation Commission of South Bend & St, Joseph County <br />125 S. Lafayette Blvd, South Bend, Indiana 46601 <br />Mailing Addis ss: rtvir%h),_ry Buildzng, C-44, U. -At A.1.1T"g"4ml <br />Phone- 574-235-9M - Fa)c 574-235-9578 - Email SBSjCHPC@=st-jMephin us <br />Websitp-, http://wwwsqosepbmwqizidiana.com/qcbp/indexhtml <br />OFFICE USE ONLY >>>>> > DO NOT COMPIX-M ANY ENTRIES CONTUNED IN 7MS BOX.»»» OFFICE USE ONLY <br />Date Received IZ47r—r- -1414 Application Number �, L-10 /'2- - " 1 2- 4 <br />Past Reviews: El YES (vote of Last itaim) <br />Staff Approval authorized by: (W <br />2TO <br />Title: <br />Historic Commission Review Date: <br />E] Local Landmark [Jocal Historic District (Name) ("1,V&2W_XU-4 <br />[] National Landmark [National Register District (Name) <br />Certificate of Appropriateness: <br />E] Denied n Tabled E] Sent To Committee ED-'Kpproved and Issued 16ZA60W16 <br />DATE <br />Address of Property for proposed work. 91 1,0 Le) ftit, <br />17 S umber and Strert Name <br />Name of Property Owner(s): (Please hint) <br />Address of Property Owner(s): 5 A. <br />Contractor(s) Name: <br />Contract Company Name, j L <br />Contractor Address: <br />(erCity: S Phone: s! <br />Current Use of Building. <br />(Single ';ly - MIIW-FCMRY -_�ommercial - Government - industrial - Varant - etc.) <br />Type of Building Construction: L <br />(Wood Frame -Brie* - Slane - Steel - Concrete - Other) <br />Proposed 11.1ork. DIn- Ind [] Landscape ❑ New [] Replacement (not in -tin=t) E] Demolition <br />(more than one ba maybe dtxW) <br />Description of Proposed Work: <br />Owm-ne /C_qn_t_ra­ctor_;%,j Fax: e-mail <br />(M 74 it xmvvnd tvith qply one <br />'A --p ,rc and/or <br />1� <br />Z <br />• <br />1J <br />