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T I F C atsh <br />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 AdArote- riurnfu South Ben Indi 4 5 e 01 <br />Phone: 574 - 235 18 - F= 574-215WB • Erna. sgcHPc@cost-josePhjn <br />Websit-- bttP.//Www.st der httd <br />OFFICE USE ON4Yz DO NOT COWLMANY EN7FM CONTAINED IN THIS BOX ;-:,,)*>�,- OFFICE USE ONLY <br />Date RecelvedJAIL, Application NumberIALL - 0 <br />Past Reviews. ❑ YES (DX, ;[]NO <br />Staff Approval authorized by. <br />31de. <br />Historic Commission Review Date: 7 <br />n Local Landmark Local Historic District Qv--4 ( API 11' VA ( L <br />[3 National Landmark National Register District ovaml <br />Certificate of Appropriateness: <br />E] Denied [] Tabled ❑ Sent lb Committee [] Approved and Issued <br />DATE <br />Address of Property for proposed work: o T'C' To rev-c- <br />StMiNumbffad Simi NOM <br />Nam of Property Owner(s): (Ftmer hint) At %;t to In <br />Address of Property Owner(s): Z 0 1-14 p 7 t-Ine c- e <br />Contractor(s) Name: /1 f, 3 14 ) V. <br />Contract Company Name. <br />Contractor Address: <br />City! Phone: <br />Current Use of Building- A> 4 It r- I <br />(Single — FM17Y - MaItiamqiv - I-GftMMMf -Indotrial - Vq=t -fto <br />Type of Building Construction: 1/ &A P <br />Proposed Work: In-kind ❑ Landscape R New ❑ Replacement Wt hojn4 ❑ Demolition <br />(=a than cm box maybe diedad) <br />Description of Proposed Work: i e3 d o r) CT1 e^j <br />T <br />r <br />Owner/�:=q(br I= e-mail <br />mid/or <br />APPLICATION REQUIREMENTS ARE US7ED ON REVERSE SIDE <br />