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From:City of South Bend <br />To:82359578 <br />Application <br />-FOR- <br />10/26/2011 11:51 <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 466501 <br />Mailing Address: County -City Bui)dingI South t3end, Indiana 46601 <br />Phone: 574-235-9798 • Fax: 574-235-9578 - Email: SBSjCHPC@co.st joseph.in.us <br />Website: 1-ittp://,Aw-A,.sqosephcounqindianacom/sichp/index.html <br />#478 P.0021004 <br />a <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONMINEV IN THIS BOX »»» OFFICE USE ONLY <br />Date Received a6 L16t a0!/ Application Number jg.0 //— _ JQ,Z G <br />Past Reviews: [PfhrJ (Wafr of L0 Review) [] NO <br />Staff Approval authorized by: Title: _&ze1W1 <br />Historic Commission Review Date: <br />[_j Local Landmark cal Historic District (.Dante) ,RIF K:gl / - <br />[_ National Landmark EKI�atlonal Register District (tvan,e) <br />Certificate of Appropriateness: <br />[] Denied [] Tabled [ Sent To Committee (Approved and Issued'��� <br />DATE <br />Address of Property for proposed work:_� �{ -�A) t S- J i <br />reit Nunrbrr and Sf ert No <br />Name of Property Owner(s): (Please Print`) <br />Address of Property Owner(s): --y ;LH <br />Contractor(s) Name: ` TJV�k <br />Contract Company Name: 1�-t! l— I6AI <br />Contractor Address: 5 `9 4 5' o LL tn� �� <br />City: sn�`,V S� Phone:�� <br />Current Use of Building:_51-A}le Fl�lt l � em- 1-DObC%e <br />I <br />�ithyle Family -Multi -Amity - Commercial- Governmeat - Industrial - Vacant - etc.) <br />Type of Building; Construction: WOOD F:9-ftYy\G <br />(WA)d Frame - Brick - Stonr - Sted - Concrete - Ofhet ) <br />Proposed Work: Ain -kind [] Landscape C1 New Replacement (int in-kind) [ Demolition <br />(mom fhan one bay may be rhWI-cd) <br />Description of Prod�'q sed Work: J � 16W. .. �- � �� WiOO <br />AIt:--.7i) (S-Il.,tkk �--I)OW lt)S06 LOM. KJ'5- <br />9'.p' -p— bKxcy Chi rn,� <br />Owner/Contractor: <br />('fhc� t+{in r' trill tronxsjxirui tnith nnty nur d+MiS rtrc) <br />yy�pAt)N CE�i-isfi <br />car 1' a: ,- is l; {n c�trP P 1,,r- P, Gf 77, -0 <br />and/or... ._.. ........... ......._ _ <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />