Laserfiche WebLink
Ir <br />Application <br />FOR - <br />CerHficaite of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S Lafayette Blvd., South Bend, Indiana 46601 <br />M2111ner AAAreev- IV—.LIL T -.J.*--- Affn't <br />Phone: 574-235-97% - Fax 574-2359578 - Emat SBSJCHPMwst josephinus <br />Website: http-//www.sqosephcounqmdmmcom/sjchp/mdexhtnil <br />OFFICE USE ONLY >>>3,>> DO NOT COMPLETE ANY ENTRIES CONURVED IN THIS BOX >>>>>> OFFICE USE ONLY <br />Date.Recelve -U,(/ Application Number 2.!eLL - 6 <br />Past Reviews: DYES (Date .1Lad&W=) ❑ NO <br />Staff Approval authorized by. <br />Historic Commission Review Date: <br />El Local Landmark � Historic District piame) <br />E] National Landmark [] National Register District (mame) <br />Title: <br />Certificate of Appropriateness: <br />E] Denied E] Tabled E] Sent To Committee E] Approved and Issued <br />DATE <br />Address of Property for proposed work. 10,X1 <br />S;Q Number and Street Name <br />Name of Property Owner(s): (Please Print) <br />Address of Property Owner(s): ii,"):) (7_Wn" ;,,*7 ti- 0. (�e,(.4 I K, 4- (Ii I <br />Contractor(s) Name: Mn,4- <br />Contract Company Name: <br />Contractor Address: C16'11: 9 veil <br />City- 11,4 .4-G53r, Phone: 34-3 <br />Current Use of Building. 1r; t � VA i I <br />(Single Family Multi -Family- Commercial -Government -Industrial - Vacant -dc.) <br />Type of Building Construction: CA'ke,- <br />(Wood Frame - Brick - Stone - Steel - Concrete - Other) <br />Proposed Work. [Z In-kind ❑ Landscape [] New E] Replacement (not in -End) ElDemolition <br />(more than one box may be chmW <br />Description of Proposed Work: <br />L <br />r -fit ci%_ a <br />Owner/Contractor: Fax e-mail <br />(7% ojT= will correspond with only one designee) <br />and/or <br />(f,c>1-;;r7a t�L, <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />t <br />