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Application <br />- FOR - <br />Certi f icate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />Mailing Address: Coiuity-City Btu'lding, South Bend, Indiana 46601 <br />Phone: 574-235-9795 • F&Y: 574-2,15-9575 • Enuul• SBSjCHPC<nho.st-psephinus <br />Website: http://w«kcv.sgoseplicountyindiana.com/sjd-q,/intlexhtinl <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONMINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received—I eoLo !o Application Number oL D /d _ O g Q 7 <br />Past Reviews: BYES (Dau of Lot Review) <br />Staff Approval authorized by- <br />Historic <br />y <br />Historic Commission Review Date: <br />S �G /9�'J' ❑ NO <br />Title: <br />ow '%4.0Z oeo /'6 <br />❑ Local Landmark U�focal Historic District (name) — &auk <br />❑ National Landmark ❑ National Register District (Name) 01 <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and Issued <br />Address of Property for proposed work: W1AYAC- 'U. A, <br />Street Number arul rcet Name <br />Name of Property Owner(s): (Please Print) m e -m KA M il-A ru N i C O�JANA N <br />Address of Property Owner(s): i Z31 6. WAVfJ9- (T. S . <br />Contractor(s) Name: 'ToPA M cm <br />Contract Company Name: k&oCK .40b b C& <br />Contractor Address: 1 4 7 M +S HA WA VA AW. <br />DATE <br />S QAeZS- <br />City: 9 01STt4 Q ENO Phone: L 6q- 4 q9 2 <br />Current Use of Building N% FA M I LSI <br />(Single <br />,F'amil y —Multi -Family — Commercial — Government —Industrial — Vacant — etc.) <br />Type of Building Construction: W CSC n FOW, <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: ❑ In-kind ❑ Landscape ❑ New & Replacement (not in-kind) ❑ Demolition <br />(mare than one box may be checked) �� <br />Des 'ption of Proposed Work: I) /10U6 6W5 9 j ()CK 6IJ LCAST W& <br />L RC(LtCE Wim- Dows AND Cusc- 0&)a Im-nirwc4CA-,�jru juom. <br />tse-t✓ llmciia OgTAPnom) <br />Owner/Contractor- Far. e-mail WOW 1090. C -DU <br />(This office mtli correspond with only one designee) <br />NE011 and/or 7o NATHAN ELu4i2Ts <br />— APPLICATION REQUIREMMS ARE LISTED ON REVERSE SIDE - <br />