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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 />MailingAddress:County-City Building South Bend, Indiana 46601 <br />Phone: 574-235-9758 Fax 574-235-M • Emat SBSJCEII'Mco stjoseph3nus <br />Website: httlr//www,s§osephcmmtlhuL mcbm/sjchp/index html <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRMS CONEDUD IN 719S BOX »»» OFFICE USE ONLY <br />Date Received a U o20 / f Application Number _4A / /— _ D 50 d- V <br />Past Reviews: ❑ YES (a* o f Gut Awew) ❑ NO <br />Staff Approval authorized by: <br />Title: <br />Historic Commission Review Date: <br />❑ Local Landmark 2facal Historic District pv.) 6.1th ,► I <br />❑ National Landmark ❑ National Register District Qvamal <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled <br />❑ Sent 7b Committee ❑ Approved and Issued <br />DATE <br />Address of Property for proposed <br />work '11.3o e R3T 1rvAY/Va- <br />Shat Number and Stmt Name <br />Name of Property Owner(s): (Please Print) M ArrHew Q Ic Mi;c1RA.-{ r3. o a M <br />Address of Property Owner(s): <br />1159 L--Y}Sr . wAY„r <br />Contractors) Name: <br />C -HAW NOMC5 5 w7r C-4ASE <br />Contract Company Name: <br />CHASE- M o M eS e,« <br />Contractor Address: <br />t t y q q W t c -la t tvS' OLIVE <br />City <br />0 o Fri. Phone: 5 -71f -M6-15-76 <br />Current Use of Building <br />S t ^+ a La F*m t w <br />(Single Family -Multi -Family -Commercial -Government -Industria! -Vacant -etc.) <br />Type of Building Construction: <br />tn)QpD r�M E . ,`7' age t uc &7>zau02 <br />(Wood From - Brick - Stone -Sled-Concrete -Other) <br />Proposed Work [:]'In-kind ❑ Landscape E'New ❑ Replacement (not in-und) ❑ Demolition <br />(mm than am box maybe dx&4 <br />Description of Proposed Work <br />DF~t-LSH 4rM•&K4;0 OVA444 <br />CAM S MU t1- 2- S1/bIA/ 4401770ti3 IH iWA 2 d4 <br />• <br />('(Or`tC P� �'tT4GK�r0 (7�ianrG3 <br />Owner/Contractor. I= 5-7y- a-niall C H A SC. Ayor c_ --3 <br />(M offia Will mrspond with ly igna) <br />x C � .�it�--- and/or _ <br />& orr ClUse , c owTxAc7z9. <br />-- APPLICATION REQUME& ENl'S ARE LISTED ON REVERSE SIDE — <br />