Laserfiche WebLink
Application <br />-FOR- <br />C'eM icate' of Appropriateness <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http:!/www4osephcou*indianiLcom/departments/SJCHPrmdox.htm <br />p: 574-235-9798 f: 574235-9578 e: SBSJCHPC(a�co.st= joseph.imus <br />OMC•E USE ONLiO>>">R NOT COMP�.'t,,F.UMNTRIES CON7 AWED iN CHL <<<<<<OMCE USEONLY <br />Date Received: /k$- 27td- <br />y AppiicatioaNumber: u2'O/oZ DaJl.S <br />Past Reviews: YES (A* qfLaW X99 .) ❑ NO /� <br />Staff Approval authorized by: / ✓ Title: .((lt�f� <br />Historic Preservation Commission Review Date: <br />Local Landmark Local Historic District (Nmw <br />❑ National Landmark ❑ National Re&ter District (Nowrl <br />Certificate of Appropriateaen: <br />Denied ❑ Tabled ❑ Sent To Committee proved and issued: <br />tease Print) <br />Mdress of Property for proposed work: _ ! <br />(Street Number—'Street Name—Gly—Zfp Code) <br />Name of Property Owner(s): <br />Address of Property Owner(s): <br />Name of Contractor(:): <br />Contract Company Name: <br />Address of Contract Company: <br />Current Use of Building: <br />Type of Building Construction: <br />Phone#: -6-f �Z-,52D 3 —x/33 <br />(Street Number— Street Name—City--Zip Code) <br />Phone #: <br />(Street Number—Street Name—City—Zip Code) <br />(Sln Family—Muldi-Farm ommercid—Government Industria!—Vacan(--etc.) <br />(Wood Frame—Brick—Stone--Steel—Concrete--tither) <br />Proposed Work: �-Kind ❑ Landscape ❑ New ❑ Replacement (not In414 ❑ Demolition <br />(more than one box may be checked) <br />Owner/Contractor Fax M <br />(StgffWiII Corr with only -one designee) <br />X <br />Sigaatu'L o wner <br />e-mail: <br />and/or X <br />S' ature of Contractor <br />n <br />