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�r <br />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 <br />AAA Building, South Bend, Indiana 46601 <br />Phone: 574 - 235 -9798 - Fax 574235 -9578 - Email: SWCHPCQco st josephjrLus <br />WeWte. hq: / /www.stjosephcounq /s chp /indmhtrnl <br />OFFICE USE ONLY » »» DO NOT COMPLETE ANY ENTRIES CONAINED IN THIS BOX » » > » OFFICE USE ONLY <br />� <br />Date Received a X 4 012 Application Number c20 X02— oya I- <br />Past Reviews: [q'IES (Date of Lasf Review) 4 .9,0 / 4 F] NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: 14 .44VUZ OW/- <br />Local Landmark .2'6cal Historic District (Name) r• <br />National Landmark ❑ National Register District (Name) <br />Certificate of Appropriateness: <br />E] Denied ❑ Tabled F1 Sent To Committee E] Approved and Issued <br />DATE <br />A <br />Address of Property for proposed work: WdiMf. 14 <br />/ treet Number and Street Name <br />Name of Property Owner(s): (Please Print) T)a 'eA Kn 4iAL CdIQ,V' <br />Address of Property Owner(s): nips F _ U I1 L� n y1 S}-��Jnd 1N 4LPl - <br />Contractor(s) Name: Id Ia. W'nAawl a^^eC yoor - CCts' pr fro n L 1) avt �Alri. Q.r, Mae h 1 <br />Contract Company Name: e o\ (.� ; a ow �, I Do o r - <br />Contractor Address: .5 60 ^ 1 i ova Udv -f Rd. c -Ea, T—N . 4 63.6 4 <br />City: C,r 6.r -6ov% , IN . t Phone: 2kq ) ?4 2 " 19 L"T <br />Current Use of Building: I 5l I C rll1 t[4 <br />(Si. Ye Family — Multi- Family — Commercial — Government — Industrial — Vacant — etc.) <br />Type of Building Construction: W00A PV <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: In -kind F1 Landscape E] New tK Replacement ( not in -kind) 0 Demolition <br />(more than one box may be checked) <br />Description of Proposed Work e4 I door 1� <br />��ack k� <br />_ t 3lu a 11 Vk ULM r As pw M.S. 1+o4t- vK d00r- n 0-6 o ri o a ( 4 h ous e- <br />Owner /Contractor: Fax: e-mail 01 n i C I h q'GG 1-►C r Q C o M C u3'�• h �'� <br />(This office will correspond with only one designee) <br />33 9 r 2 0'77 and /or - <br />— APPLICATION REQUIRLMENTS ARE LISTED ON REVERSE SIDE — <br />