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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: SBSjCHPC@co.st-joseph.in.us <br />Website: http://www.sgosephcountyindiana.com/sjchp/index.htn-d <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received // t1e# ,b_.20// Application Number -.9-0 <br />Past Reviews: � (Date of Inst Review) /j [j NO <br />Staff Approval authorized by: (� Title: <br />/v <br />Historic Commission Review Date: <br />E] Local Landmark Eil'foeal Historic District (Name) to • [U� <br />Ej National Landmark 0 National Register District (Name) <br />Certificate of Appropriateness: <br />E] Denied E] Tabled [_j Sent To Committee 5Kpproved and Issued Lf&,'A � <br />DATE <br />Address of Property for proposed work: <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) 1 0 n nCA_ P_ ('i r- 5ghu r n <br />Address of Property Owner(s): X2.-3 6 C t/,)t.�n e Af . J <br />Contractor(s)Name: 'A--4'" Josi-lu r\ N- i t ,l - <br />Contract Company Name: A-V C ONST e_l i u lit 1s c> t- C)5(. E O L R, t- L. L <br />Contractor Address: r29 -LAR <br />City: D'. C.e 00� -- /nnI � U(U�IP ( Phone:..5-74 - &1 4 -NZZ& <br />Current Use of Building: .`moi nI)) e- # G rni l �o <br />�J (Single Family — Multi -Family — Commercial —Government —Industrial —Vacant —etc.) <br />Type of Building Construction: w o U A -Fr L•i rrc <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: E] In-kind ❑ Landscape ❑ New replacement (not in-kind) E] Demolition <br />(more than one box may be checked) <br />7 <br />Description of Proposed Work:' t • ��+toor of ro�`f lY2GfD{'1�15� / ✓ <br />t et At'1�j �l/,s tiu ltCg-jut,7' i (.Selye', -1 9'_1('- f <br />'Peel I f L LG9/JGIIY) i C ) r. Y h fel /ti wl ✓f t) f"T <br />Owner/Contractor: Fax: 5 7H - to 1 q " Ci Lt I O e-mail vt s1rIA ( YN Cc, S h We a 1 • to e f <br />(This will-corres�rnt rth g•n of ^des' ) <br />f and/or <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />