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Application <br />- FOR - <br />Certi f icate o f 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: 574235-9798 - F=574-23-'-%78 - Email: SBS)CHPC®co.st josephin.us <br />Website: htW//www.sgowphcounWdiamcom/gchp/index.html <br />OFFICE USE ONLY »»>i DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received oci,o go poll Application Number 20 1 1 - 090 9 <br />Past Reviews: YES (Date of 1.1 Reoiem)l'1 !� ❑ NO <br />Staff Approval authorized by:el.-d, ;Q Title: &?L �-- - <br />Historic Commission Review Date: <br />❑ Local Landmark [� Local Historic District (Name) /j 6 U 0 y- <br />❑ National Landmark ❑ National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied _ [:]Tabled ❑ Sent To Committee ❑ Approved and Issued � 0�• " <br />DATE <br />Address of Property for proposed work: ---31? < _ _LpcX,4Ld& 'tE DR <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) P4:44 L 41-16 501r C% o 1; s <br />Address of Property Owner(s): -30S' x. flQ . <br />Contractor(s) Name: �Ac ' •s Sn I ,, s► 4;== •s <br />Contract Company Name: .l1.�/�ieIE Io�F-e A,;&k <br />Contractor Address: loaf '4 Kms P-0 A n <br />City: Phone•9/`y9! <br />Current Use of Building- L <br />(Sinvgle Family —Multi-Fami y —Commercial — Government —Industrial — Vacant —etc.) <br />Type of Building Construction: { r 1,�., n e, f -r rr ^-,-E <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: U In-kind ❑ Landscape ❑ New ❑ Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: l t e_ 14 %A0j gj_- 5� t cs.a cE <br />Owner/Co or. Fax: e-mail <br />(T1a mrr d with only one designee) <br />X/ \ and/or <br />— APPLICATION REQ UIREMEINTS ARE LISTED ON REVERSE SIDE — <br />