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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 />MA41irm A County—City Building, South __3 Indiana Lana 4660 1 <br />Phone. 574-235-9798 * Fax: 574-235-9578 * Email: SBSjCTIPC@cost­josephmus <br />Website htipr//www.stjosephcountyindiimcom/Ichp/indexhtmI <br />OFFICE USE ONLY >>>>>> DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX >>>>>> OFFICE USE ONLY <br />Date Received ifLI "') -I 1 Application Number7'j:)_j_L_ - 1111-A <br />Past Reviews: * N�YES (Date of Last Reukw) 4 -1 � . )( s 9Y � ] n- — .0 <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: <br />Local Landmark 1 I Local Historic District (Name) V) <br />National Landniuk dNational Register District (Name) rx � i h Y9h <br />Certificate of Appropriateness: <br />Ej Denied [] Tabled [-] Sent To Committee E] Approved'and Issued <br />DATE <br />Address of Property for proposed work:_-91,::� �' MOJld 11e47U 0 <br />yy Street Number and Street Name <br />Name of Property Owner(s): (Please Print) <br />Address of Property Owner(s): ?)/A%c�Caw'Plu"o 5'74 - 233-3533 <br />Contractor(s) Name: r) I.XJ POIR <br />Contract Company Name: <br />Contractor Address: <br />City: Phone: <br />Current Use of Building: <br />(Single Family - Multi -Family - Commercial - Government - Industrial - Vacant - etc.) <br />Type of Building Construction: <br />(Wood Frame - Brick - Stone - Steel - Concrete - Other) <br />Proposed Work: E] In-kind R Landscape R New <br />[O <br />(more than one box mqy be choked} .,p (not in-kind) Demolition <br />E] <br />Description of Proposed Work: izRp[a( �e wifh j C 0 — wen vinyl <br />m) Indouis -6 hqn'-Fr'.h Omathaj Nndoud <br />Owner/Cqntractor,r F *e-mail <br />(TVs oce oorr�etspq, with dyo)ndesignee) <br />0- and/or <br />Z #.A4 Z>4 APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />