Laserfiche WebLink
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 josephinus <br />Website httpr//www.sqosephcountyindfimcom/s chp/indmhtml <br />OFFICE USE ONLY»»» DO NOT COMPLETE ANY ENTRIES COMMINID IN TINS BOX »»» OFFICE USE ONLY <br />Date Received X02 Application Number 2LO AV Z <br />Past Reviews: []YES (Date e f tact ReuLQ NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: <br />Local Landmark ❑ Local Historic District pvame) <br />National Landmark . E] National Register District pvame) <br />Certificate of Appropriateness: <br />E] Denied ❑ Tabled E] Sent To Committee E] Approved and Issued <br />DATE <br />Address of Property for proposed work: 'go <br />n treet and Street Name <br />Name of Property Owner(s): (please print) l / <br />Address of Property Owner, cKS <br />Contractor(s) Name: _jrt?E 04712— <br />Contract Company Name: <br />Contractor Address: r C} LSP f �- S� <br />City: Phone: <br />Current Use of Building: <br />(Single Famil Multi -Family — Commeraal —Government — Industrial —Vacant -etc.) <br />Type of Building Constructio <br />(Wood Frame — Brick — Stone - Steel — Concrete — Other) <br />Proposed Work: In-kind ❑ Landscape ❑ New. [] Replacement (not in-kind) Demolition <br />(more than one box Wray be checW) L <br />Description of Proposed Work: <br />_CO A Pt- 6T� '7'�A � F� 4 �� /2A�F Lt1 /Tff ��S�iFi¢L? r4�C�• <br />,591,-tq cr-.5 - z/csf�r_,e_ kW 77-e- ! AGE <br />Owner/Con F e-mail <br />(This of 1a wiil d only one ) <br />and/or <br />— APPLICATION REQIIIRF.MMS ARE LISTED ON REVERSE SIDE — <br />