Laserfiche WebLink
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: 574-235-97'98 • Fax 574.235-9578 • Emal SR%CHPC®co.st joseph hus <br />Website: htty//www-gmphcountyindivmcom/sjchp/index html <br />OFFICE USE ONLY »»> DO NOT COMPLETE ANY ENTRIES CON LINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received % V�W4 Application Number WO - OGD 7 <br />Past Reviews: ffrES (Date of Last Review) ❑ NO <br />Staff Approval authorized by. Title: �—Z6 , bbl <br />Historic Commission Review Date: <br />❑ Local Landmark ❑i'Cocal Historic District pvame) C�� �at�t✓ <br />❑ National Landmark ❑ National Register District pvame) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent 7b Committee E j Approved and Issued 7 °ZOIC <br />DATE <br />Address of Property for proposed work:_. 005 .tgCx _V ve of L <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) Joan Paw tiS <br />Address of Property Owner(s): 8 V4 F0 •-es �- A vG o u fA arced r 1-16 & <br />Contractor(s) Name: rad Pe c�so n P c r c r, n C� �• �,l. fv C' o .-z c f r� �-iv� <br />Contract Company Name: <br />Contractor Address: <br />City: 'M t cAac 7a k -e, <br />Phone: <br />Current Use of Building- i i Alen f ­*7 <br />(Single Family —Muk'-Family —Commercial —Government — Industrial — Vacant —etc.) <br />Type of Building Construction: W o o d-F`rQ." e <br />(Wood Frame - Brick - Stone - Steel - Concrete - Other) <br />Proposed Work: XIn-kind ❑ Landscape ❑ New ❑ Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: r- oi r 41x2e� von L Q f- eek / A au Cc <br />Oil <br />Owner/Contractor: Fax: e-mail `i Orn d a c.. t ns I u S,b - edey <br />(This office udll correspond with only one designee) <br />and/or <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />