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Application <br />- FOR - <br />Cer%r' fi'cate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />Mailing Address: County -City Building, South Bend, Indiana 46601 <br />Phone: 574-235-57 8 • Fax: 574235-9578 + Email. SBSJCfFC@cost josephin us <br />Website: hU ://wwwsgowphwunq in&ma com f 4rhp/indmhtml <br />OFFICE USE ONLY» »» DO .NOTCOMPLETEANY ENTRIES CONnINED W THIS BOX »»» OFFICE USE ONLY <br />Date Received •� Application Number020/0 - 0 ?� � <br />Past Reviews: 0 YES (Data of Last x ) <br />Staff Approval authorized by: <br />N1,01 <br />Title: <br />Historic Commission Review Date: /Y e0l 0 <br />[i Local Landmark [Dlocal Historic District (Name) , )9 ,1 <br />[❑ National Landmark �atlonal 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: A -t2- �i 17 C' . `3,0 -c 7H P?F-0 J <br />Street Number and Street Nance <br />Name of Property Owner(s): (Please Frim) <br />Address of Property Owner(s): <br />Contractor(s) Name: <br />Contract Company Name: <br />Contractor Address: `-; —7 —7 + : P <br />City: '% I i A / Phone: G= 7 4� <br />Current Use of Building: * C', le e . r 1. <br />(Single Family -Multi Family - Commercial- Goumnient - Industrial - Vacant -dc.) <br />Type of Building Construction: 61J 0 z <br />(Www Frame -Brick- Stony - Skd - Canade -Other) <br />Proposed Work: [Ufin-kind E]Landscape [] New [-1 Replacement (not in-kind) []Demolition <br />(more than one b= may be d=W) <br />Description of Proposed Work: .dr- <br />r,rt1 Ccs <br />C. t" .CC, l� 7°7C-; J�."'�.�:��,"r" A 7- <br />Owner/Contractor: Fax: e-mail <br />(M ojfux will ronrsl+t d with only one designee) - <br />'-- and/or <br />J <br />