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Application <br />- FOR - <br />Certi, Cate of f Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />ltihtiting Address— —j.ty -City Building, South Bend, Indiana 4(111 <br />Phone: 574- 23s -M • Fax 574-MM • Email:- SBSJCHP'C6co st jc ah inus <br />Website: http: / / www.s"hani ntyindiana.com /sxhp /index html <br />- OFFICE USE ONLY > » »> DO NOT COMPLETE ANY ENTRIES CONFINED IN TKIS BOX > > > »> OFFICE USE ONLY <br />Date Received 1 / Application Number <br />Past Reviews: [] YES (rwe of Last ) F1 NO <br />Staff Approval authorized by: <br />Title: <br />Historic Commission Review Date: f 0jZe"_ C ,2 011 <br />❑ Local Landmark Cgl l Historic &strict (Neme) <br />[] National Landmark glational Register District (rvame) <br />Certificate of Appropriateness: <br />E] Denied [] Tabled [] Sent To Committee [] Approved and Issued <br />nare <br />Address of Property for proposed work: .►�.''� c� M p,� �" � L.0- - <br />Street Number and Street Nam <br />Name of Property Owner(s): (Pkase Print)t <br />Address of Property Owner(s): Y re <br />Contractor(s) Name: t"a f. 7 „ t n 11 j%'. o r. 1 C-- P r,-r f <br />Contract Company Name: <br />Contractor Address: <br />City. <br />Phone: <br />Current Use of Building- _,_„__.F .-^/_ /,p <br />(Single Family- Multi - Family - Cbmmerciat - Government - _industrial - Vazant -etc.) <br />Type of Building Construction: 6 c� c r { <br />(Wood frame - Bark - Stone - Steel - Concrete - Other) <br />Proposed Work: ❑ In -kind ❑ Landscape New [] Replacement toot in -kind) ❑ Demolition <br />{inure that one bm may be dre&4 q,, 3 i,& Q <br />Description of Proposed Work: - rat h c` 4 � tea �•- �.7 t rr c <br />A 1< 1 <br />Owner /Contractor: Fax: e-mail S' A- 77 - C7. <br />{ l3t rs will mrrrttpond with atfymte designee} <br />"0 �� and /or - <br />-- APPUCATTDN REQWRi:MMMEE M ARE LISTED ON REVERSE SIDE — <br />