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E <br />Application Z�evwz <br />- FOR - <br />Certfflcate 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 -Cty Building, South Bend, Indiana 456tH <br />Phone: 574 - 2359'7 8 • Fax 574235 -9M • Email: WCHF'C@cost josephin.us <br />Website: httlr//wwwAosephcountyindiana .com/sFhp/=IexhtnI <br />OFFICE USE ONLY» » >> DO NOT COMPLETE ANY ENTRIES CONVIINED IN THIS BOX >> »> OFFICE USE ONLY <br />Date Received / 4 .W f/ Application Number L,* fl _ 0 7 o , ,4 <br />Past Revlews: 9 (rat .-Of Lost M*W) ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: <br />[] Local Landmark 2fAocal Historic District (Name) e; - <br />National Landmark [] National Register District pvamt) <br />Certificate of Appropriateness: <br />[] Denied n Tabled [] Sent To Committee [A Approved and Issued <br />f° DATE <br />Address of Property for proposed work: t '� ' ' 0- <br />S mbn and Srctt Name <br />Name of Property Owner (Please Print) CiC_� to Sct i <br />Address of Property Owner(s): +m' <br />Contractor(s) Name-' � ' S <br />Contract Company Name: „ "* <br />Contra r Address: 1 ` t C41 c tc C A -0 � <br />City ��t�c��,- .-tCS' Phone:�� <br />Current Use of Building <br />(Single Family — M ulti- F amily — Commercial — Cmrnmrnt — Industrial — Vacant —ttc.) <br />Type of Building Construction: k3 � '�`"'� r-- <br />(Wand Frame — Thick — Stone — SW — Concrete — Other) <br />Proposed Work: In -kind Fl Landscape F] New [] Replacement (not in -kind) [] Demolition <br />(more than one box may be drr C ,_,.,,,._ <br />Description of Proposed Work- � �' � �` D- i 4' � - ” � � r` - c- <br />O o ctor ar a -mall <br />(T.�is'�ra r ontyo igrut)� <br />and /or <br />-- APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />