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Application ' <br />-FOR- <br />Certi <br />Certificate of Appropriateness <br />Historic Pceservat[on Commission of South Bend & St Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46601 ►� . <br />Mailing Address: County -City Builduig, South 8aid, Indiana 46601 <br />Phone 57423.5-9M Fax 574235-578 EmaiL SB5JC PCQoo st-j0sePh-i'1us <br />Website http://wwwshosePhootmti}!Indiar mm/q&p/mdex.html <br />OFFICE USE ONLY»»» DO NOT COMPI M ANY ENTRIES CONMRM IN BOX »»» ONCE USE ONLY <br />Date Received'Iljd,4 aZd!/ Application Number <br />Past Reviews:❑ YES (Date r f Lut lam)O <br />Staff Approval -authorized by: Title: <br />Historic Commission Review Date <br />❑Local Landmark []?.oval Historic District (111amt) <br />❑ National Landmark CrN"ational Register District (rlaate) <br />Certificate of Appropriateness <br />❑ Denied ❑ Tabled [] Sent To Conwgn tee ❑ Approved and Issued <br />DATE 4 <br />Address of Property.for proposed work <br />,r� 6eet N and Shut Name <br />Name of Property Owner(s): (Fkae Print) _! `� C( !�([ ` °:- <br />�S <br />Address of Property Owner(s): <br />Contractors) Name: rn 7 t') Cl tr 49 !S" G e % f �, �J�) a h L.I ('. is -'7 A -a. C, <br />Contract Company Name:ert:`v ��` <br />�Contractor Address:� <br />City: l ) $ 11 JGL - V 6, > � 0 Phone: <br />i { <br />Current use of Building: S' I i' f? a !� Li <br />(Single Farmly—Multi_aMi y — Commadal— Gaudn=nt — Industrial — Vacant — etc.) <br />Type of Building Construction: . tk C" C GC <br />(Wood Frame — Brick — sim —Steil— Conaete— Otho) <br />Proposed Work. 0 In-kind ❑ Landscape ❑ New Weplacement (not in-kind) ❑ Demolition <br />(more than onebar arty be the dW) ` p <br />Description of Proposed Work <br />-10161 _ <br />-a - 1 i�ca U S (u,'s"bc s <br />Owner/Contractor.. F= °) % y 1 3 3 e-mail rn Cq <br />(i1usaf"nzwMwrrrspmtdtvAotdyoned77�1 <br />lC ) )//and/or j�iQi"l_ /L' <br />� I <br />�APPLTCMTONREQUIREAENTS ARE LEST ED ON REVERSE SIDE — <br />