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Application <br />-FOR- <br />Certificate of Appropriateiiess <br />Historic Preservation Commission of South Benxi & St. Joseph County <br />12- S. Lafayette Blvd., South Bend, Indiana 6601 <br />Mailing Address: County -City Building, South Bend, Indiana 46601 <br />Phone: 574-2..35••9798 - Fax: 574-235-9:578 • Email: SB5jCI-II1C&o.st-joSeph.in.us <br />Website: ti iviv.stjosephcotuitvindi=ana.cotn/sjchp/indc�x.litnil <br />A Certified Local Government <br />OFFICF. USI: ONLY> >»> DO NOT CO.'VII'LEII: rtrb"1' 1?NTIZIES CONTrlINk7) IN 7F11 S BOX—-- OHICG USE ONLY <br />Date Received / Cr -r- ,Z (11 Ci Application Number � U 1 t1 - 100 / A <br />Past Reviews: C] YES (Daae vf Uat Ret=ie � NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: AF t�GC 2-010 / <br />C] Local Landmark } ] Local Historic District G'vanie) F <br />[]National Landmark [ National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled [_] Sent To Committee Approved and Issued <br />DATE <br />Address of Property for proposed work: <br />;dame of Property Ocvnee(s}: {I'leasr� I'rirrt) ( cr l!%' :•�'•�"" <br />Address of Property Owner(s): t-5� % p, r), l c <br />Contractor(s) Name: l�,4e<- <br />Contract Company Name: <br />,�K,l e., <br />Street imaher and Street =Name <br />Contract or Add s: /J_ �- <br />Cit}: # ti � ll �".�r.�'"1 Phone: 'i ,.t�ct'-- S""•� t='�' <br />Current Use of Building: <br />{Sirr;teT�mi`-Mtdhi-I'areitr- commercial -Govertim?d-Indiistriai-•Vac=utt--etc-) <br />Type of Building Construction: <br />1$h� Brick, - Stent Stec? -- Concrete - Oth=er) <br />Proposed Work: E] In-kind [] Landscape [-] New ,Replacement (not in-kir,,=t) [❑ Demolition <br />(mare iha?t v?v tm rrta✓icchci:ked) <br />Description of Proposed work: -7 F at e i,,r✓'= irf��. � (+ /--7 -°~7 -W F ° <br />U f C? r.t _.r: e t t, -i 7 L4 tf ' t`� a� <br />�sU vn+ rl :ontrartor: lax: , �1 C� - -�5 e-mail . cL.. e,4 <br />t'73 i+ i ro: rr A!1d With ar <br />and/or _._.._._. <br />Sis4utttVof Owncr Skgnahtre of Contractor <br />— r11'I't;ICt1T1i7N REQUIIt1;,'471:NTFS ARE 1.1517..1.) ON REVERSE SIDE — <br />