Laserfiche WebLink
o�TApplication <br />-FOR- <br />�:'� C"ertifcate ofAppropriateness <br />HISTORIC PRESERVATION COMMISSION <br />• 1866 ' of SOUTH BEND & ST. JOSEPH COUNTY <br />I25 S. Lafayette Blvd., South Bend, IN 46601 <br />httpi/www4osephcountAdWii4com/departiuents/SICBPrmdex.htm <br />p: 574-235-9798 f. 574-235-9578 e: SBSJCHPC@co.st joseph.in us <br />0MCC US90AM rt�sa»M2 NOT GOMPL• NY ENTRIES CONTAMED M HOX �OP1°7C� tW OMY <br />Date Received: a 5K /� Application Number. 02� / "' -- ' 4 7 d 2— <br />Put RcvIcWr. <br />PutRcviews: YES (DW#gf%+aXevk►) ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark <br />National Landmark <br />Certificate ofAppro riatenen: <br />11 Denied Q Tabled <br />Local Historic District (Nam)' <br />❑ National Register District (Naw4 <br />❑ Seat To Committee ❑ Approved and issued: <br />(Please Print) <br />Address of Property for proposed work: 1 � ail, i_ f s: i n_ +�� � _r sr l'' ��"� 'V /3 <br />(Street Number—SYr et Name—Ci)—Zip Codej r Nui�5 �✓ 3 - J 3 cr <br />Name of Property Owner($): I-Iv.%,A-e wa r ✓_5 Phone ti: 04•44,,-. &7q) 3 $r7 -4 v 3d <br />Address of Property Owner(s): -30-t S 1,; <br />(Sheet Number—StreetName--City—Zip Code) <br />Name of Contractor($): 5,e,.( r1 Phone M 1-2 t 't ) 6 S J— a a, t y <br />Contract Company Name: Adw,... <br />Address of Contract Company: <br />(Street Number— Street Name—City—Zip Code) <br />Current Use of Building: S" t v h y y <br />(Single Family—Mutt-Fdmily--Commercial—Government--Industrial--Vacant—etc.) <br />Type of Building Construction: s., ev s4- P�.�-�.r•� <br />. '(Wood Frame—Brick--Stone--Steel--Concrete—Other) <br />Proposed Work: ❑ In -Kind ❑ Landscape ® New ❑ Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: 4 C n 5�".r^k c F s lett 5 iia i b ,,,z k o f F tip <br />f fiv <br />r � <br />Sties( -to b� ! c ,.,,.,,,1 w r,c.. Nrv, tld ,r►wvz . -tr A.+4- <br />Owner/Contractor Fax M e -mall: <br />(Staff will correspond with o ly one <br />Xry ,�/ LL E and/or X J <br />Sigaatu�Eof Ow r (� f �T t i l t N S re of Coa19(dor <br />