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Application <br />- FOR - <br />Ce i ficate <br />Certificate of Appropnateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Lafayette Blvd, South Bend, Indiana 4WI <br />X4-:12 Address: County-CityBuilding, South Bend, Ind-na 46601 <br />Phone: 574-235- - Fax:574-235-9578 - Email: SBSJCfll-'C@Mst-j()SePtLimus <br />Website, httV://www.stjoseplicountyincthui&coin/*hp/index.htini <br />OFFICE USE ONLY >>>>>> DO NOT COMPLETE ANY ENTRIES CONTI INED IN THIS BOX >>>>>> OFFICE USE ONLY <br />Date Received Application Number <br />Past Reviews: (Daief 1,ait 1Zme0_4 A�q� 07-0/1 nNO <br />Staff Approval authorized by. <br />Title: <br />Historic Commission Review Date: 01 <br />D Local landmark [t�ocal Historic District vV-.4 <br />National Landmark n National Register District (Name) <br />Certificate of Appropriateness: <br />n Denied F] Tabled 0 Sent To Committee approved and Issued DAM <br />Address of Property for proposed work: 3o4 • fw**MffAH Pf <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) Almgr_ &44.r-t_hro <br />Address of Property Owner(s). 504 8- 'rrJ*-V-SA14Af4 Vg� <br />Contractor(s) Name: �� 5 4.,7T- &W <br />Contract Company Name: MA04— Sle.&Tr <br />Contractor Address: J 5145 j!idmu.,, D 1`21 Ve- <br />City.-_rive Phone: 57-t <br />,4,+WA4A . td_4&546 <br />Current Use of Building- Z-11HII&S- fir tl4.'( <br />(Single Family - Whi-Family - Commercial - Government - Industrial - Vacant - etc,) <br />Type of Building Construction: WCT> ftAtiA— <br />(V*od Fraena' - Brick - Stone - Steel - Concrete -(Other) <br />. X -.- <br />Proposed Work. 4 In-kind n Landscape n New E] Replacement (not in-kind) F1 Demolition <br />(inorr than one bat may be chechd) <br />Description of Proposed Work: 6V44'rr1A0'4;t- A 64VE- <br />/vr,*LHal D Z. chi-~ &,VAA&f-. &9_,_Asf_ <br />F"pu_q6 <br />t <br />Owner/Contractor. Fax:_0, e-mail S.0 <br />(This office will c am-Nyond with oirly one daignee) <br />an'd/or 57+ 651 - *0 <br />571- W' Itis 0&qr-) <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />