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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 Building, South Bend, Indiana 46601 <br />Phone: 574 -235 9M • Fax. 574-235 - Email: SBSJaUCC@co.st josephm us <br />Website: http: / /wwwstjosephcoun" dm&com /odip /mdex.html <br />OFFICE USE ONLY » »» DO NOT COMPLETE ANY ENTRIES CoArAINBD IN TINS BOX » »» OFFICE USE ONLY <br />Date Received_-6VI.A 2E - W,(! Application Number d 4 ! / - 0 ¢D <br />Past Reviews: V) YES (Date of last &am) ❑ NO <br />Staff Approval authorized by. Title: <br />Historic Commission Review Date: <br />❑ Local Landmark Local Historic District (Name) S- WaYW &-fit <br />❑ National Landmark ❑ National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and Issued <br />,` l' DATE <br />Address of Property for proposed work: `t I �I Ul i1£ Sffe.�+ <br />_ Stmt Number and Street Name <br />Name of Property Owner(s): (Please Print) � } I J LVnn cl ty e <br />Address of Property Owner(s): 14 E Wa-Ine 4reet <br />Contractor(s) Name: Orr m e ( V1 Oq <br />Contract Company Name: Q 1.tC1.1 i +-V 1A YdocJ f t6v 14 C <br />Contractor Address: 9 C R 3 a () <br />City: - E v i1Gtt^'}" , LN L16 Phone (s - 7(1 ) 90 a —1613 <br />Current Use of Building: �5* vl le -Pn M i V ' <br />U (Single Family—Multi- Family — Commercial — Government — Industrial — Vacant —etc.) <br />Ty at pe of Building Construction: l i t im i n j of S i dd (1 Sao d frtu , )lP hO u S e <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: ❑ In -kind ❑ Landscape ❑ New .Replacement (not in -kind) ❑ Demolition <br />(more than one box may be dined) r <br />Description of Proposed Work - I a er j SOCS e..0 OT Iq dottf je Win <br />+ ry P if)& I hifec tw i ll �; C0rrPr* Ma*-uin nma(Aed fycte d8icerO hV` f <br />Q �i,tylii�luM Had t.tAvido�t)S, N •tJlltndcc3Wx Weire a_ Ve"'s or crav - i n <br />i <br />Lk "L : 6, 1�xf� renovk1m• Sa -P iii 6e` ;t - Mat (n Af of ha e-0ack <br />Owner /Contractor: Fax NIA a -mail �'c-� t (� �n S ©GCrLD81�L � iVE 7 � <br />(This office a with on77; <br />and /or <br />v SrS <br />— APPLICATION REQUnU3MM ARE LISTED ON REVERSE SIDE — <br />