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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 Address: County -City But�ding, South Bend, Indiana 46601 <br />Phone: 574-235-798 • Fax 574-235-9578 • Email: SBSJCHPC®co.stjosephin.us <br />Website: http://wwwsgosephcountyindimmmm/odip/index html <br />OFFICE USE ONLY>>>>>> DO NOT COMPLETE ANY ENTRIES CONRPJED IlV THIS BOX .»»» OFFICE USE ONLY <br />Date Received Atpr 010/0 Application Number <br />Past Reviews: ❑ YES (Date of Lot Review) BM <br />Staff Approval authorized by: Title: A"46-4.; <br />Historic Commission Review Date: , <br />❑ LocalLandmark [gocal Historic District Name) <br />❑ National Landmark D-Pational Register District pvame) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee [<pproved and Issued 4 "1 7 o7'0/0 <br />'DATE <br />Address of Property for proposed work Ra t+ ` �t i r , <br />f Sheet Number and Street Name <br />Name of Property Owner(s): (Please Print) �1 n 9 .� u r.�.� Q c e <br />Address of Property Owners): S xw r- <br />Contractors) Name: v v <br />Contract Company Name: <br />Contractor Address: &7 <br />City: d 4 Phone• —4 <br />Current Use of Building. x,,.: <br />(SingFamgy —Multi-Fami7Commerciat— Gos�errtment —Industria! —Vacant —etc.) <br />Type of Building Construction: <LCe_<n <br />(Wool Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work219--kind ❑ Landscape ❑ New ❑ Replacement (not in -End) ❑ Demolition <br />(more than one box may be d=b d) <br />Description of Proposed Work: gcx Ca' <br />Owner/Contractor. Fax: / e-mail <br />(This office tf correspondu»t1 ily an designee) _ <br />f and/or <br />— APPLICATION REQUIREMBNYS ARE LISTED ON REVERSE SIDE — <br />