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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 -qty Building, South Bend, Indiana 46601 <br />Phone: 574-235-9798 • Fa)c 574-235-9578 • Email.. SBSJQdPCC&o st joseph.in.us <br />Website: http://wwwsqosephcounqindiana.com/s chp/index.htn�l <br />OFFICE USE ONLY-- DO NOT COMPLETE ANY ENTRIES CONTUNED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received /F yX«y O// Application Number oL0 - 0 67 <br />Past Reviews: YES (Date of Last Review) -} NO <br />Staff Approval authorized by: Title: A't; .a,iJ <br />Historic Commission Review Date: <br />❑ Local Landmark Deocal Historic District (Name) G - A)A � , <br />National Landmark � e) Q National Register District (Nam <br />Certificate of Appropriateness: <br />Denied E] Tabled E] Sent To Committee [202!Cpproved and Issued 40 A� 07-0 /f <br />'DATE <br />Address of Property for proposed work: 1 ZZZ GAGS-' WAy NE 50ktV" '�% TJAi It (a (o l S <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) �4M i d O�r�� CO:.r� L Ea,val-�,rYti <br />Address of Property Owner(s): a -S 4 trema. <br />Contractor(s) Name: U we_% <br />Contract Company Name: <br />Contractor Address: <br />City: Phone: <br />Current Use of Building: %MC:. <br /><�mgle Eamr!o-Multi-Family - Commercial - Government - Industrial - Vacant - etc.) <br />Type of Building Construction: "3r'►CAC_ <br />(Wood Frame - Brick - Stone - Steel - Concrete - Other) <br />Proposed Work: In-kind M Landscape E] New _ Replacement (not in-kind) n Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: R=P14C � �G'�T-r'�a�rd�"}� Aq ttJC�Ode^ IP&MLe. Irl <br />.baXV- c urd. Lawes iS reoVi-c r t}- tx �+r% Cts. owl ew wo(Aep% <br />t'�+C.l� �tY'1 `'�1rti f�..o�- S4►'�c'. IbCs�lnOr� Q.S OIC. �c'eno�°_ . <br />Owner/Contractor: Fax: dLMcb% -Z.Z Q cor" e" -mail <br />(This office ung correspond with only one designee) �- <br />and/or <br />— APPLICATIONREQWREAR2MARE LISTED ON REVERSE SIDE — <br />