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.r - <br />Application <br />- FOR - <br />Cerci f icate of Appropriateness <br />Historic Preservation Commission of South Bend & St Joseph County <br />125 S. Lafayette Blvd., South Send, Indiana 46601 <br />Mailing Address: County -Cary Suncun% South Bend, Indiana 464n1 <br />Phone: 574-235-9798 - Fax 574-235-9578 - Email: SBS avwco st-pephu us <br />website: http://wwws§osepha=4 indima=m/*Ip/in o html <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONVIINED IN THIS BOX »»» OFFICE USE ONLY- <br />Date <br />NLYDate Received —d—1c20/6 Application Number61 <br />� p � � . •� / � . <br />Past Reviews: ❑ YES (Date ofLast lievkv) <br />Staff Approval authorized by: d�%L�ti.w,.? Title:�'''�eeG✓ <br />Historic Commission Review Date: <br />[] Local Landmark D4 ocal Historic District (Name) <br />[1 National Landmark [t hiational Register District ovame) <br />Certificate of Appropriateness: <br />[] Denied [1 Tabled (� Sent To Committee [<pproved and Issued f 07-6'1'0 <br />"DATE � <br />Address of Property for proposed work: <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) o, �" <br />Address of Property OwnerLtts): �-/ <br />Contractors) Name: <br />J <br />Contract Company Name: <br />Contractor Address: _. <br />City: �ti+c< t Phone• <br />Current Use of Building. ��1==u <br />(Sing't�Family —Multi-Familyl Commercial — Government —industrial —Vacant —etc.) <br />Type of Building Construction: <4' <br />(Wood Frame - Brick - Stone - Steel - Concrete -Other) <br />Proposed Work: 2<.kind ❑ Landscape ❑ New n Replacement (not in-kind) ❑ Demolition <br />(mm than one boa may be du+rlad) <br />Description of Proposed Work:fL c e�=-W J � <br />.� wl.G )'ttmv�att <br />Owner/Contractor. Fax: t , e-mail <br />(This of f�cr correspond uritf ty designee) _ <br />and/or <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE -- <br />