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Application <br />- FOR - <br />Certifreate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />175 S. Lafayette Blvd., South Bend, Indiana 46601 <br />Mailing Address: County-Caty Buildin- South Bend, Indiana 46601 <br />Phone: 574-235M • Fax 574-235.9M + Eman: SwCMF0@co sgoseph.inus <br />website: http:l/www4osephCDunq* dia mxbm/sxhp/kO htmi <br />OFFICE USE ONLY >>>>>> DO NOT COMPLETE ANYENTRIES CONUMM IN TWS BOX »»» OFFICE USE ONLY <br />Date Received Z " Lo t / Application Number "j -a // _ 10 - ",b <br />Past Reviews: ERM (Dateof Leatbvi W) ❑ NO <br />Staff Approval authorized by. Title: <br />Historic Commission Review Date. / ll <br />[] Local Landmark Local Historic District (Name) - ! <br />National Landmark 0 National Register District pvame) <br />Certificate of Appropriateness: <br />(� Denied E] Tabled [] Sent To Committee E] Approved and issued <br />DATE <br />Address of Property for proposed work: �� s . /11�►-�iLt - <br />Street Number mrd Street Name <br />Name of Property Owner(s): Onn se Print) it K-1 C1 " <br />Address of Property Owner(s): ` lr ! , tt j I- <br />Contractor(s) Name• �1E-E� F `� fA <br />Contract Company Name: _116 2 IJIF-t_ 41all j -5.s.o 6; A I � <br />Contractor Address: �:ua=i �` j KE& A.; k. n �4 n <br />City. ` i n j- k P t: K, n, f Phone: <br />Current Use of Building: ` �,a M <br />bitif mLV—Muni-F4m4—Commmial —Government—Industrial — Vownt —rtc) <br />'type of Building Construction: tA-.-'JS 0 n rr A M, e - <br />(Woad Frame — Bp_rkk — Stone — Steel—Conrnte —Other) <br />Proposed Work: ❑ in-kind ❑ Landscape ❑ New ;@ Replacement (not tri nd) ❑ Demolition <br />(more than one bar maybe efiedz4 <br />Description of Proposed Work: _ M t _ &0l3' - A2 * . ^ <br />r,"jou4OA74A JAR k 4,1j. <br />—� <br />—1 4 4 <br />Owner/Contractor: <br />(Tkls o�ccr wr7l , <br />t <br />,x?/-:. / e-mail <br />and/or �f <br />APPLICATION REQLURFMENIS ARE US= ON REVERSE SIDE — <br />- <br />v► <br />