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W <br />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 County -City Budding, South Bend, Indiana 46601 <br />Phone 574235 -9798 - Fax 574 -235 -9578 • Emad: SBSJCHPC@co.st josephmius <br />Website http: / /www.stj Thcountyind=&com /*Ip /mdmhtml <br />OFFICE USE ONLY » »» DO NOT COMPLETE ANY ENTRIES CONI UNED IN THIS BOX » »» OFFICE USE ONLY <br />Date Received -4.44 -e 020 Application Number 02O <br />Past Reviews: ►[ s (taneof astReview) [-] NO <br />Staff Approval authorized by. p Title. <br />Historic Commission Review Date: AF ' dAv • 026 / <br />21GDcal Landmark ❑ Local Historic District (Name) <br />✓]National Landmark F1 National Register District pvame) <br />Certificate of Appropriateness: <br />n Denied E] Tabled E] Sent To Committee n Approved and Issued <br />- DATE <br />Address of Property for proposed work: ?'�- a0 A tcf.��� 5twce <br />j , Street Number / and Street Name <br />Name of Property Owner(s) (Please Print) At'v l S ��+� ''� =-'►4 / 1'v-f - s c44%e <br />Address of Property Owner(s): Zit No�(4 Mtat�3gr aH. Sr�f •ride" <br />Contractor(s) Name: /j�0+ <br />Company Name: _ ^t -% S Ck 4 Q -g A, mk: •ve <br />/}vt.(�, <br />L". Address: <br />City: 54k I s , Phone: 288 - ?- ' O M <br />Current Use of Building_ <br />(Single Family — Multi - Family — Commercial — Government — Industrial — Vacant — etc.) <br />Type of Building Construction: /� �•SoM ✓y <br />(Wood Frame — Brick— Stone— Steel— Concrete — Other) <br />Proposed Work: k In - kind Landscape 0 New replacement (not in Demolition <br />(more than one box may be dredxd) <br />Description of Proposed Work: (•.ce. rs i'F �.k►:� f'+1tn.l Q.t�.'t"� oQeo r' S ; <br />rt S + •�w.f 7's+1 ....( i • k •'i..d' /'c a &C-el 44.4 •J wfN .QoW S. <br />° 3 <br />C CfoT: Fax: e-mail GN4-r�`Z �,D�.rwts CA. (As e f to '�. �1 <br />(This office will correspond with only one designee) <br />and /or <br />— APPLICA77ONREQUIREMEN'I'SARE LISTED ON REVERSE SIDE — - - <br />