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Application <br />FOR - <br />Certificate ofAppropriatenews <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND Sc ST. JOSEPII COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />littp:Hwuw.stjoseplicountyindiaila.com/dep,irtmejits/SJCI I P/index.htill <br />p: 574-235-9798 f. 574-235-9578 e: SBSJCIIPC Cdco.sljoseph.inms <br />0FF10EU.V1; 0.N MM'CONIPLEIT ANVENTR I LS CONTA INFO IN TI [IS R0N—<<<<0FF10EU.5E0,V1.f' <br />Date Received: L4 T - It Application Number: .10 <br />- t <br />Past Reviews: I <br />❑ NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date- 0?0 <br />❑ Local Landmark Fa-'Locat Historic District txamr) dl&4� laal <br />❑ National Landmark D<N ations I Register District (:vamt) <br />Certificate of Appropriateness: <br />❑ Denied 'fabled ❑ Sent To Committee ❑ Approved and issued: <br />H <br />(Pli Print) <br />Address of Property for proposed work: Avt I I & <br />(Street A- Name — City - Zip Code) <br />Name of Property Owner(s): Y Q an (jt Phone #: <br />Address of Property Owner(s): - 42, - 3 4't I sAa ", N t1 6 ('0 4? <br />(Street Nionber— -Street NaYne---Qv-----Zip Cade) <br />I I ck, a <br />Name of Contractor s): �WLV,� Phone#: 5��q <br />Contract Company Name: iw, Pal <br />Address of Contract Company: T, l3b q- CM- cooA beJ IN <br />(Street iNumber-= Streel.Mame Citj- ill Code) <br />Curren( Use of Buildina: F414:1 <br />.. . .... .. . .......... <br />(Single etc.) <br />Type of Building Construction: trv4 Fm/wo <br />... . ..... .. <br />Proposed Work: In-Kind <br />(more than one box maj gj'� <br />be <br />Of'ood Frame- -Brick <br />T.andscape 0 New <br />Description of Proposed Work: <br />Owner/Contractor Fax <br />(sl(?f U'l C' rc')onc1 with onlmle <br />t ignee) <br />x <br />Signature of 0 , ner <br />Stone Steel - C c�rrc'rete C }tker) <br />❑ Replacement (not in-kind) ❑ Demolition <br />e-mail: LYDEi � e�bilfbu <br />and/or X <br />Signature of Contractor <br />