Laserfiche WebLink
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 Address: County -City Building, South Bend, Indiana 46601 <br />Phone: 574-235-9798 • Fax: 574-235-9578 • Email: SBSJCHPCQcost joseph.in.us <br />Website: http://www.sgosephcountyindiana.com/s chp/index.html <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONRINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received ell 12tv- -.LO/d Application Number -10 /,0 - 40,Pa 7 <br />Past Reviews: { 'ES (nate ofWt Review) /G xo�v OW16 n NO <br />Staff Approval authorized by: �f Title: <br />Historic Commission Review Date: , <br />❑ Local Landmark Egl�oeal Historic District (Name) <br />F] National Landmark E] National Register District (Name) <br />Certificate of Appropriateness: <br />Denied ❑ Tabled E] Sent To Committee ERA"'pproved and Issued 044cW"o <br />DATE <br />Address of Property for proposed work: ;,.a % 6i 7- h A-IA/E -'�WiE' Act -u-71 <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) A FF r- PAIL -i /.3'iC/cEr- <br />Address of Property Owner(s): ,A-iwe <br />Contractor(s) Name: 7-6b <br />Contract Company Name: <br />Contractor Address: <br />City: <br />Phone: <br />Current Use of Building, s1NE7 i e f-PsM I L u <br />(Single Family — Multi -Family — Commercial — Government — Industrial — Vacant — etc.) <br />Type of Building Construction: 7-541 c-fc- <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: In-kind [:] Landscape E] New E] Replacement (not in-kind) ElDemolition <br />(more than one box may be checked) <br />Description of Proposed Work: 'iZ,-ni_AC E C-7A2A&rte' G 077-CYZJ <br />•." 31Cid !Lf (/l.G-111A9A/C-1 c'c).ri t.,is r yrij (I A 10c 1- /,1/1//L,72'7L/K(,- - <br />Owner/Contractor: Fax: 4 l 5 g -7 c% G 8 6 `/ e-mail �U ►Yt t �a a h rc (Gd /�t fit t UP C c) �� <br />(This once unTl correspond with only one designee) <br />and/or - <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />