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Application <br />- FOR <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />.125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />Mailing Address: County -City Building, South Bend, Indiana 46601 <br />Phone: 574-235-9798 • Fax: 574-235-9578 • Email: SBSJCHPCQco.st joseph.inus <br />Website: http://www.sgosephcountyindiana-com/Ichp/index.html <br />OFFICE USE ONLY>>>>>> DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received �t . L(' . 7V I Application Number <br />Past Reviews: � YES (nate of cast Review) r)Cd R NO <br />r <br />Staff Approval authorized by: <br />Title: <br />Historic Commission Review Date: , <br />E] Local Landmark L] Local Historic District (Name) �a t 11,C (41 <br />National Landmark ❑ National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied E] Tabled [] Sent To Committee ❑ Approved and Issued <br />Address of Property for proposed work: �0 �J • 1 vjiu*F-4 Fi7H D'+ - <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) j$0Ct-;t.-t,,tW t A* <br />Address of Property Owner(s): &-I &• I -Ou* i li7m top <br />Contractor(s) Name: 12461L 6C4> rr <br />Contract Company Name: <br />Contractor Address: <br />City: <br />Phone: <br />DATE <br />Current Use of Building: F*-((r_'Y filtVsP— <br />(Single Family — Multi -Family — Commercial — Goverment — Industrial — Vacant — etc.) <br />Type of Building Construction: fJoot& <br />(Wood Frame - Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: [J3In-kind E] Landscape F] New Replacement (not in-kind) E] Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: J 1611) , L0.-->r1Pr4 Lr A.(- V L -A -(L <br />tM i�?W ,O_ &4&0-0 I +VUsF-' <br />- li t/-Iocv) F,95111& /role tb (494—P D rt'( 1,41— i4A.-w TV(Li��C-Z_ <br />H A T►G qP- o f;:r f . W art (Z-1 t -A3 i?> 1 4*- HA-F-4)ifl Wc;waf-) 6ASX A-.6 -tL <br />Owner/Contractor: Fax: a 14- e-mail <br />(This office will correspond with only one designee) <br />LO( - 760 • (306c (GF-c,�-7 and/or .74 1_9 1 6b (fdo-ti) <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />