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,A <br />'i <br />Application <br />FOR - <br />Certificate of Appropria <br />teness <br />STORIC PRESERVXnON COMMISSION <br />. . . . . . . . . . <br />of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette 131vd., South Bend. IN 46601 <br />htlp://i <br />p: 574- 23 -9798 5-9798 f. 574-2 C: SBSJCIIPCfi. <br />... . . <br />.... ..... ... ........... ........ ... ... . . ....1 . . . ........ <br />OFTICF USE0AT3>x,->>>D0 NOTCOMPLETF ANY ENTRIES CONTAMD USE ONLY <br />Date Reccilt ed: 7 d4z? - Application Number 07d1cZ OX4 7 <br />Past Reviews. DYES (M1r0j-1,LV1R0W,) FT NO <br />Staff Approval authorized bv-. <br />Title: <br />Historic Preservation Commission Review Date: <br />... ........ M11111111 <br />Local 1 <br />j el <br />❑ .1 11 ❑ 1 1 hi s t oric ". <br />Mal Lr e <br />J ..ocfl store District ) <br />❑ National Landmark ❑ Natit)nailtegisterl)istriet(.vdm, .......... ..... <br />Certificate of Appropriateness: <br />❑ Denied Fabled ❑ Sent To Committee ❑ Approved and issued. <br />(Please Prins) <br />Address of Property for proposed work: F-51 E--. Way tA <br />(Sireei iVainber --.Yrreei Xcitne - City- Zp Cexle) <br />Narne of Property Owner(s):G Lue h a & 6 re- <br />Phone#: S - 7 <br />Address of Property Owner(s): e-- <br />(Street Yunther— Street Xame .0tv Zip Code) <br />Name of Contractor(s): o,4- t' )- o iix- ix Phone 5 L/- 7,5 - 7qYS <br />Contract Company Name: Cvv- C\e r-c, <br />Address of Contract Company 1 S <br />ber— Streel.Name City— Zip <br />Current Use ol'Building: S , �Jtpl <br />j 1 ami -F C 4 <br />-a <br />- y - <br />(.Sin 5in e / .... Afulti-fland —Government - - InMfried- - Vacetnt- -etc.) <br />Type of Building Construction: Woo& F z a (' 1 - A M-C 1 9 11 J i Vt- <br />.. .... . ... . ... — - ------- . .... . - <br />(lf'oodl.ratne Brick-.-Slone—Steel • Concrete - -- Other)' <br />Proposed Work: FlEn -Kind ElLandscape ❑ New Replacement (not in-kind) ❑ Demolition <br />/snare than one box in,ry be checked) <br />Description of Proposed over 6ac k -P -f <br />. ... . .......... <br />-.51 fl 6 Pi . t T - Ak 4 <br />. . ......... . <br />. ...... . .. . ....... <br />Lqc &-K i RO. -t,,-- t... --��-kojp <br />4wner/Con tractor Fax #:S - 7qn <br />_a3-�- - 753L- e -mail: JLrikucd e Ck lam.- f`00 -A�s g C C) wA, <br />(Su?ffivill corresjiond with only one desigi�i2w) <br />X and/or <br />Signature of Owner a re of Contractor <br />—APPLICATION REQUIREMEN ARE LISTED ON REVERSE SIDE, <br />