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Application <br />- FOR - <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />Mailing Atitirokiv County-CityBuOding, South U—A I-A.ana— Aemi <br />Phone: 574-235-97% - Fax: 574-235-9578 @ EmaiL-SBSJCIiPC@co-st-joseph'ULUS <br />Website: http-//%ww-sqosepl=unq*diana.com/sjchp/index.hbnl <br />OFFICE USE ONLY >>>-D0 NOT CO,,VPLETEANYENTRIESCONRMWnV'nIIS BOX »»» OFFIC USE 01%'L*Y <br />Date Received 7 xCpt Application Number ��6/0 toO 7 <br />Past Reviews: E1YES (Dee VfU$fP_-V,kW) <br />Staff Approval authorized by: <br />Historic Commission Review Date: ow V6,44 "/6 <br />E] Local Landmark [gi:ocal Historic District (Name) <br />National Landmark Fj National Register District (Name) <br />Certificate of Appropriateness: <br />[]Denled. n Tabled E] Sent To Committee ] Approved and Issued <br />Address of Property for proposed work:w -:5 <br />Ame <br />Title: <br />Street Number mut Stmt None <br />Name of Property Owner(s): (Pimse print) 90P,_6 -7-,V L/ 014L_ <br />Address of Property Owner(s): Pa- <br />Contractor(s) Name: <br />Contract Company Name: <br />Contractor Address: <br />City. <br />Phone: <br />VATF <br />Current Use of Building: 14 " L <br />(Single Fandly - Multi -Family - Commercial - Government - IndusIrw - V4=nt - Cie.) <br />Type of Building Construction: <br />1/(Single <br />D <br />(Wood Frame - Briek - Stow - Steel - Concrete -Other} <br />Proposed Work: Fj In-kind (] Landscape [ New n Replacement (not in-kind) olition <br />(more than ore &x may be checked) <br />Description of Proposed Work: P&G_. P,41A /_X/vo <br />Owner/Contractor. Fax: I e-mail <br />(M- office Uq5nrSMVf tvit 11Y OneI w) P014 <br />and/or <br />APPLICA77ON REQUIREMENTS ARE LISTED ON REVERSE SIDE -- <br />