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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: 574-2359M • Fax 574-235-M • F.mal- SBSJCHPMo.st joseph.inus <br />Website: http://www.s§osepha)unVhdimacbm/sj hp/index.html <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONni NED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received 9 " "y o20// . Application Number za / / _ 0.50 9 <br />Past Reviews: Ej YES (note of first Rei eco) NO <br />Staff Approval authorized by: Title: Attu_ <br />Historic Commission Review Date: <br />❑ Local Landmark g6cal Historic District pvame) e, <br />National Landmark ❑ National Register District (Name) <br />Certificate of Appropriateness: <br />E] Denied [] Tabled ❑ Sent To Committee E3Approved and Issued 9 �' 'W// <br />DATE <br />Address of Property for proposed workL., c Y�� 1.. d, 3�,1 <br />\ Streettuber aWd Street Name <br />Name of Property Owner(s): (Place Print) \) c_ . <br />Address of Property Owner(s):r <br />p�� L : r r) \ k,. , . �� . �t <br />Contractors Name: A h (,-.;Ir. <br />Contract Company Name:87 <br />0th, .r, vl'�r <br />Contractor Address: S`P ,� �: t\ <br />• 1 cl kc., A _R t t.X-A . <br />City. -_E'..''. t a iA . - Phone:' -33 9 9 Xr-5 . <br />Current Use of Building• �+ r.(i <br />� injle Family -Multi Family --C mmercial - Government - Industrial - Vacant - etc.) <br />Type of Building Construction: _��Ca; , e <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: aln-kind ❑ Landscape ❑ New ❑ Replacement (not in -land) ❑ Demolition <br />(more than one box may be dxdz4 i <br />Description of Proposed Work: <br />Owner/C tractor: F S751y - StLt �- t�1Ct �t <br />(This ' 1 compond ith ly one designee) " <br />. i'7 3 f t^ ,__ and/or <br />�r . <br />e-mail /YKrC, fiwS�rc•t• 4-«....fr$ � V�4C-0 f <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />