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r'• <br />Y <br />Application <br />.FOR. <br />Certificate of Appropriateness Q <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND & ST. JOSEPH COUNTY <br />125,S. Lafayette Blvd., South Bend, IN 46601 <br />httpd/www.slosephwuntyMana.com/deputments/SJCHPrmdmhtm. <br />p. 574-235-9798 f: 574-235-9578 e. SBSJCHPCQa cost joseph.inus <br />OMCEUSHONLP»»>RQEQ COMrnt,EMAMLRMWZ <VMWunomF <br />Date Received: S ��r%.Z Application Number: a 2. d '7/) <' <br />Past Reviews: 11 -YES twoltml ONO <br />Staff Approval authorised by: <br />Title: <br />Historic Preservation Commission Review Date:/ - <br />v � <br />❑ Local Landmark ® Local Historic District pvaw4 <br />❑ National Landmark ❑ 'National Register District pv.1 <br />Certificate ofAppro riateness: <br />Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) <br />Address of Property for proposed work: r E � S7� � `;-r , r� <br />{Street Number~ -Street ame-City-•Zip Code) q <br />Name of Property Owner(s): / /� ' L t Gae4?f Phone #: r( <br />13 <br />Address of Property Owner(s): Q ©k )q tl 11V 11 <br />(Street Numbers -Street Name -City -Zip Corse) <br />Name of Contractor(s): Phone #: <br />Contract Company Name: <br />Address of Contract Company: <br />(Street Number-- Street Name--Ci)j-Zip Code) <br />Current Use of Building: 10 <br />(Single F ultHFami ommercia"overnment-In tusft*d--Yacant--etc.) <br />Type of Building Construction: t �rs*► r+� t <br />(Wood Frame --Brick -Stone-Steet-Concrete-U'ther) <br />Proposed Work: ❑ In -Kind ❑ Landscape %New, ❑ Replacement (nat in -R4 ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: •Tim tie -.W saaA1 +J 0r� <br />�;,�, . r_s t~�;,�Zrl . ti-, «�. ,� e7 c-: m a•�, � �"e i.. a,�r c� - � <br />-L,y�� Nt,rkt•. !;;C � ^ �`} t � r' i-.c''•cc� - is �i +r `1 I %Z1 �c.Rt7r�trLg'tcc <br />1a1 --X4 txvuI N: L�C*c:C SC i1QY►M. <br />c: <br />Owner/Contractor Fax #: e-mail: <br />(Staff wig corn spond wit one desknee) <br />X and/or X <br />Sipat a of Owner M ; C' j4,( o: t_, ,4 X-Im Signature of Contractor <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SID&- <br />