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Application <br />- FOR - <br />Cei*ficate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />175 S. Lafayette Bikd, South Bend, Indiana 46601 <br />Mailing Address: County -City Building, South Bend; Indiana 4661)1 <br />Phone: 574-235-4748 - Fa:c 574-235-9578 * Email,- SBSJCHFC@rn st josephan us <br />Website: http://wwwstjosephcountyin lmm com/sjchp/indexhtn-d <br />OFFICE USE ONLY» » >> DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received *5 %2l ,Vebv eY of011 Application Number aid <br />Past Reviews: [BYES (notegr txeui.) NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: __ __ 4Y_%Z4-�rJ.ogjl . d/ <br />E'Local Landmark [] Local Historic District (Name) <br />[] National Landmark [] National Register District {Name) <br />Certificate of Appropriateness: <br />Denied [] Tabled [] Sent To Committee [ Approved and Issued <br />DATE <br />Address of Property for proposed work: WesN &k tr-� <br />,ii ` <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) tit c=-��t e-bat'rx <br />Address of Property Owner(s): a \ h ecr\ <br />Contractor(s) Name: "It VY'-- 0 Ue("N'+4jjW— <br />Contract Company Name: VAfNM&C.:o S t C -k n S . <br />Contractor Address: P 10 <br />City: A tzc�ax t `='cs t{ 6-sCs1 Phone: <br />Current Use of Buildin <br />(SingleFam75-7r55Z- <br />(Wood <br />Multi-Family—Commerntial— Government — Industrial — Vacant —etc.) <br />Type of Building Con_ struction: .��?'eFrame — Back - Stone — Steel —Cow& — Other) <br />Proposed Work: ❑ In-kind [] Landscape [D New ❑ Replacement (not in-kind), [] Demolition <br />(mora than one box may be checked) <br />Description of Proposed Work: t t fir. 0-fr '5� %rAtt c <br />x )4 t ` d-(t.t e.k Q ( tarn t n ov^ 4':>' P y <br />Owner/Contractor: Fax: 5-1 a . $ q 1.511 U e-mail <br />(M office twill aorresF with only one designee) <br />and/or <br />— APPLICATION REQUIR£ME M ARE LISTED ON REVERSE SIDE — . <br />