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r► <br />Application <br />-FOR - <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />175 S. Lafayette Blvd., South Bend, Indiana 46601 <br />Maiiing Address: County -City Building, South Bend, Indiana 466()1 <br />Phone: 574 - 235 -1798 • Fax 574 -2Z-M - Email: SBSJCHPC@cost josephin.us <br />Website: httg: / /www.sgosTh ountyindkmcom /4d p/i idex.hb3d <br />OFFICE USE ONLY » »» DO NOT COMPUTE ANY ENTRIES CONTAINED IN THIS BOX » »» OFFICE USE ONLY <br />Date Received 16- P-1 `. Application Number 0 1 0 _ //_ - 0 715 <br />Past Reviews: D YES (Date of Last Review) BNO <br />Staff Approval authorized by: <br />Title: <br />Historic Commission Review Date: k5_ OW// <br />[] Local Landmark E3 Historic District (Namr) ( ado r <br />n National Landmark- [National Register District (Namr) <br />Certificate of Appropriateness: <br />[] Denied E] Tabled [] Sent To Committee ❑ Approved and Issued <br />DATE <br />Address of Property for proposed work: '(�' :3 4 1 f (; <br />Stmt Number and Street Name <br />Name of Property Owner(s): (Pkase Prin O N vi r) m • <br />Address of Property Owner(s): n q P�7 < k OCC L1 4 G t C <br />Contractor(s) Name: AT 0- <Ter t,'Vr ! <br />Contract Company Name: <br />Contractor Address: <br />City <br />Phone: <br />Current Use of Building:___, 5 wA ;d : F- 40y;1 -r <br />(Single Family — Multi - Family — Commercial — Government — Industrial — Vacant — etc.) <br />Type of Building Construction: Lr rare� F'-nme <br />( Wood Frame — Brick — Stone — SteeI — Concrete — Other) <br />Proposed Work: ❑ In -kind [_] Landscape [] New @ (not in -kind) ❑ Demolition <br />(more Om one bas may be chedzd) <br />Description of Proposed Work: I 'I "I "We �� . r % i el(a� " ix+ tT/ a"Y I el'; Ir'4v <br />Owner /C tractor. Fax: a -mail <br />(This of= eorresmnd rh ly mu desipa) <br />and /or <br />— APPUCA77ON REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />