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16 <br />W= <br />Certificate ofAppropriateness a Y <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http: t/www.stjosephcountyffidiana.com/departments/SJCHPriadex.htm <br />p: 574-235-9798 f. 574-235-9578 e: SBSJCHPC@co.st-joscphAn.uS <br />..... .. .. . . <br />OFFICE USE ONL <<OFFICE USE ONLY <br />- Date Received: Application Number: <br />Past Reviews: ❑ YES (Date of L- NO <br />Staff Approval authorized by: Title: <br />HiAoric Preservation Commission Review Date: <br />❑ Local Landmark ❑ Local Historic District (team,) <br />❑ National Landmark ❑ National Register District (vaw) <br />Certificate of riateness; <br />Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) <br />Address of Prop" for proposed work: <br />(Street Number— Street Name—City—Zip Code) <br />-), 0- 7'q <br />Name of Property Owner(s): X' Q. � q& Phone #: 7 <br />Address otProperty Owner(s). Ll I So A 9 d IV L14 6 3 q <br />(Street Number — Street Name—Cio—Zip Code) <br />Name of Coutractor(s): VOIL.M�eler-s Phone N: <br />Contract Company Name: <br />Address of Contract Company: <br />(Street Number— Street Name -- City —Zip Code) <br />Current Use of Building: <br />(Single Famil —Multi-Farnity-,LCommorcial—Government—Induitrial—Vocant--eic) <br />Type of Building Construction: <br />�(ii'ood Frame: -•owret.--Other) <br />In -Kin ❑ Landscape ❑ Replacement (not in-kinr ❑ Demolition <br />Proposed Work: e New <br />(more than one bar may be checked) <br />4 <br />Description of Proposed Work: Re'06CA—' -R r <br />!wACnC I + �X-- <br />. I I CX '�' <br />CL�Ielt>' '-'4 47��ryi 1'-N1 W s pr- occ-�. <br />4" 1 <br />k-40� I C e- -4 64 H 'Z 'U L., <br />Owner/Contractor Fax #: e-mail: <br />(Staff will correspond with only one designee) <br />and/or X <br />Signature of Owner Signature of Contractor <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />