Laserfiche WebLink
Application <br />-FOR- <br />Cervi f icate 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: 574-235.9758 • Fax 574-235-M • EmAt - SBSjCHPC@co st josephinus <br />Website: http://www4osepha mntyindiana•com/ochp/index html <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONURVED IN 77HS BOX »»» OFFICE USE ONLY <br />Date Received�C QI �-_. Application Number �rs11 <br />Past Reviews: YES (Date of last &e ,.) 110-11 0-1 ❑ NO <br />Staff Approval authorized by. l �� 2� Title:. <br />Historic Commission Review Date: <br />Local Landmark Local Historic District Wvame) C ,VI G I �i �✓ arl`"" 1�1I (J I �Y� <br />National Landmark National Register District pvame) <br />17 A <br />Certificate of Appropriateness: LA I <br />Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and Issued <br />DATE <br />Address of Property for proposed work: 7 Fore s 7� <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) L?e+A and 6 -low ke w n <br />Address of Property Owner(s):' '32.7 .<C•i{,4714" ��� /' 1N.#6-el6- <br />Contractor(s) Name: 6'1't' .d1 t P iSaYt <br />Contract Company Name: i► i _Zs'o n GLQI>f�%)/ 6-m5 *UC7YOA <br />Contractor Address: t�', 9 ��0 YYd .T 744 27* -33,1 <br />Ci / l l �Ar7 {n1 <br />h" ?hone: <br />Current Use of Building. <br />Type of Building Construction: <br />(Single Family—Multi Family —Commercial —Government — Industrial —Vacant —etc.) <br />(Wood Frame — Brick — Stone —Steel — Concrete — Other) <br />Proposed Work: . (3 In-kind ❑ Landscape ❑ New ❑ Replacement (not in-kind) ❑ Demolition <br />(more than one box may be dwdvar!) <br />Description of Proposed Work: aernn <br />C <br />-IL Q'14f6b 16 Q14 A at Q Qn W I� <br />Owner/Contractor. Faac <br />(This of= 671 0""rl <br />udtl{ onig (me designee) <br />V. <br />and/or <br />5 (Gkndel` 200S") qt A%P_ k©t- <br />e-mail <br />h S�i�haIP,S <br />-- APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />