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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 • ErnaiL• SBSJCHPC @' ost Joseph in.us <br />Website: http-//www.sqosephcounlyindianLcom/s chp/index.html <br />OFFICE USE ONL�>>>>>> DO NOT COMPLETE ANY ENTRIES CONRINED IN xHIS BOX »»» OFFICE USE ONLY <br />Date Received - } .{i, k • 1 I Application Numbera D I I - 0 901 <br />Past Reviews: F ES (Date of last Re kw) <br />00-F <br />Staff Approval authorized by: <br />■o <br />Title: <br />♦ 0 <br />Historic Commission Review Date: <br />Local Landmark Local Historic District (Name) <br />�] National Landmark National Register District pvame) <br />Certificate of Appropriateness: <br />F1 Denied n Tabled ❑ Sent To Committee n Approved and Issued <br />DATE <br />pt r&% <br />Address of Property for proposed work: Mo x/ W,//, 4.01 <br />Street Number and Street Name Q <br />Name of Property Owner(s): (Please Print) 1 %e firer 1;.4q Ce0" P 44o-, Oflavrlr*l j4Th �/'��� <br />ZAddress of Property Owner(s): y cAt3 Cd sen s % k3 r � Sha tJa k+ ' .TyI <br />Contractor(s) Name: <br />Contract Company Name: -- ,Y 1G- ! <br />Contractor Address: 4"4.9 <br />City: ,dtl �7t�/ . ,�».G�:44 Phone: -3 f-J��DC� <br />Current Use of Building: <br />(Single Family -Mufti-Family - Commercial - Government - Industrial - Vacant - etc.) <br />Type of Building Construction:k <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: In-kind Landscape [] New JMReplacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) f <br />Description of Proposed Work: Ka {'�/a4o- moo e i » e /S o" Aasva q .t/o/✓ 4 ,-ml a. j <br />aa1'aa¢. `No -es ra � 4 n 'P«FnT a Gc)0oct!� R_5 - il�el�a;n?';hrt <br />4S 'f b n./a! 0/i1-111e-� Vie- G�u�P f" �i;sirz+Eta/ <br />04 -rAe u; 1c1;n al�c. /(/pA1- dpQraflcyta% �[�t 3� iI` �c `�Ce� <br />Owner/Contractor: Fax: - - 4.3,27 e-mail cr-S' �i oT Chi e.�srir/��� c-ts►►1 <br />(This of wi! with oh ly one d--ignee) <br />and/or <br />— APPLICATION REQLIIRB ENTS ARE LISTED ON REVERSE SIDE — <br />