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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: SBgCHPC@costjoseph.in.us <br />Website: http://www.st osephcountyindiana.com/s chp/index.hbnl <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONRINED W THIS BOX »»» OFFICE USE ONLY <br />Date Received A1.Q,at . oW 11 Application Number O 4r2 / <br />Past Reviews: 5KTS (Date of last Rmiew) is /30/ A-ra 3 r-1 NO <br />Stasi Approval authorized by: W Title: 4cZ11 �_ <br />Historic Commission Review Date: <br />Local Landmark �ocal Historic District (Name) <br />National Landmark Ej National Register District (Name) U <br />Certificate of Appropriateness: <br />❑ Denied E]Tabled [:] Sent To Committee E?'A"pproved and Issued Of"12$/ZD!_/ <br />DATE <br />Address of Property for proposed work: 1 q 06 E. W Qqae_ St . <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) SQf bar 6L kr rj <br />Address of Property Owner(s): l q O& E. W a J n -e_ 1 <br />Contractor(s) Name: -J OSHUm 41U <br />Contract Company Name: _A, -T Co rJ ST r2v LT io N 4- QCX'1j F i rJG <br />Contractor Address: ;5914 � La. <br />City: CSS ce010- ylnSlo I Phone: 5 7y 'lo7N -N2 Zf� <br />Current Use of Building:S%If- FGm, 11* <br />(Single Family — Multi -Family — Commercial — Government — Industrial — Vacant — etc.) <br />Type of Building Construction: W (-)ocii VCv 'tee <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: E] In-kind n Landscape r] New [] Replacement (not in-kind) E] Demolition <br />(more than one box may be checked) <br />Description of Proposed Work:cowefe. AY off of rd lyla y-na Cr'tRb RPv j <br />OG,�r �,T u' sulk. <br />A_ k 1qe&e V-10II IVJUtkr kl_(4T 1h. .1) C(rUinfie LAr1dmjrlG Ser -e( <br />Gh'ift ,t <br />Owner/Contractor: Fax: J q -&7q- LIZ L/D e-mai1__ A-1 - fan rqtwatria Sb(41ob4l. net <br />(This offs rTl Po wit rn ly o ignw) <br />and/or <br />