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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 Address: County -City Building, South Bend, Indiana 46601 <br />Phone 574235-9798 - Fax: 574235-95M - Emall SWjCHPC®oo.st joseph.inus <br />Website htV://www.sqowphanmqindimmm/*hp/hulexhtml <br />ulex.html <br />OFFICE USE ONLY»»»DON T COMPLETE ANY ENTRIES COMP MM INTSIS BOX > >> OFFIGE USE ONLY <br />Date Received Application Number <br />Past Reviews: YES (Date of tutiwiw) ❑ NO <br />Staff Approval authorized by: a Title: 1Q vr <br />Historic Commission Review Date: . <br />cal Landmark �] Local Historic District (Name) A,,} Q� <br />❑ National Landmark ❑ National Register District (varve) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee Approved and Issued <br />DATE <br />Address of Property for proposed work: <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) %_175�% ��%P.�S �/ <br />Address of Property Owners): ✓ S y�.g� %� ��AA .5/7 <br />Contractor(s) Name: �>7 <br />Contract Company Company Name: <br />Contractor Address: <br />City: Phone: <br />Current Use of Building: <br />Single Famil Multi -Family - Commercial - Government - Industrial - Vacant - etc.) <br />Type of Building Construction: <br />(wood Frame - Bride - Stone - Steel - ConOther) <br />Proposed Work: ❑ In-kind ❑ Landscape [:]New Replacement (not in-kind) ❑ Demolition a'(4&V)P_ <br />(more than one baa may be dx&4 <br />Description of Proposed Work: y X1.57�%�r ��s�� 1— �� <br />Owner/Contractor. Fax_ e-� 10 t 1 i ./Thee + <br />(This r ui aaith one deli ) <br />y,y and/or ol<i5c� <br />.�.�/ bx �Icu�A <br />"(004 <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />