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A►ppRcation <br />- FOR - <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />123 S, Lafayeft Blvd., South Bend, Indiana 46601 <br />MadinS AAA..s: Countyfiity Bu1dit & South Pend, Indiana 46601 <br />Pham: 574.2;16.9M - Fax: 574235-M - Entail: SWaVCftjt-#eph.hus <br />Website:http://wwwjos plea=windfaoa.cc)M/*hP/hift.html <br />OFFICE USS ONLY »»a> DO NOT COMPLETE ANY SAr MS CONRIM IN 7798 $OX »»» OMCLe USE ONLY <br />Date Received oW11 Application Number d 0 // . 001/0 <br />Fast Reviews: WI -O ❑ NO <br />Staff Approval authorised by: �-�� Title: — <br />i <br />Historic Commission Review Date: <br />Local Landmark ❑ Local Historic District (nane) <br />❑ National I=dmark ❑ National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied ❑ 7abled ❑ Sent To Committee M Approved and Issued L- W// <br />nnT9 <br />Address of Property for proposed work- Q:P G(] Qin r` <br />Street mbar and Street Nmne <br />Name of Property Owner(s): (Please Print) Lraa- %NW' N A CULAM t L- -: �'• <br />Address of property Owner(s): 311 V( -:TF MANS 1066 <br />Contractors) Name: i`o�&(b <br />Contract Company Name.* <br />Contractor Address.* -9 ;4 Ak b e_�`� iZN r• <br />City cr C.�1 -�! Phone: <br />Current use of Buildin,-- <br />(Single E04—multi <br />,Faln — r � �Covernment—Industria.*—Vemnt—rtes <br />7j pe of Building Constructions <br />AM"jl, Hrtek —� Steel — Concrete - Other) <br />Proposed Work: [] In-kind ❑ Landscape New [] Replacement (not in-kind) [] Demolition <br />(more than me boa may de ehodW ` <br />Description of Proposed Work: cid <br />A 0 i N Za�_� J" PS°? A J - <br />tractor: Fax: —— i 1 1 u2km , Co nn <br />(7hts vias un nrayo d wittran tgxee) <br />and/or <br />APPLICATION REQWREME M ARE LISTED ONREVERSE SIVE <br />