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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 />Mailing Address; County -City Building, South Bend, Indiana 46602 <br />Phone: 574 -235 -TM - Fax 574-M9578 - E mil: SBSjCHPmo.st josephinus <br />Website: http://www stjosephcountyindiana.mm/sjchp/inde Lhtmi <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONT TUNED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received!„,,-.? a Application Number - <br />Past Reviews: 9 s (Date ofLast Ie;ew) !�L -� o2f> tt? F1 NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: c2 Y Jd <br />Local Landmark Q'Lacal Historic District {Name) <br />v <br />National Landmark [1 National Register District (Name) <br />Certificate of Appropriateness: <br />Denied [] Tabled ❑ Sent To Committee (1 Approved and Issued <br />DATE <br />Address of Property for proposed work: <br />V Street Number and Street Name <br />Name of Property Owner(s): (Please Print) je?<sp '�2 a a %� ' 2 Z Z. <br />Address of Property Owner(s): C'S �c t! .►uGr• .1�r'' <br />Contractor(s) Name: _��' <br />Contract Company Name: <br />• ti <br />Contractor Address:. c ryJcSDY7 r �-� ,,��++ <br />City: <&-e �� %✓l Phone: F7v?— <br />Current Use of Building-�4r <br />v <br />(SingleFami7y-Multi-F ity-Commercial-Government-Industrial-Vacant-etc.) <br />Type of Building Construction: <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other), <br />Proposed Work: -kind ❑ Landscape ❑ New ❑ Replacement (not in-kind) . ❑ Demolition <br />(more than one box may be checked) <br />Description of Prapo d Work: _ tva ....// <br />raj �/o = ,j7d/e JG�24 la9��a t*i� <br />i'Y1-,�', �j ✓� CIy 7Y4.S r " /N P v� I �a A2. /��i H. <br />O er/Contractor: F e-mail <br />{This re unw correspdnd ty one desi <br />and/or - <br />-- APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE -- <br />