Laserfiche WebLink
Application <br />-FOR- <br />Certificate of Appropriateness <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND & ST. JOSEPH COUNTY ' <br />125 S. Lafayette Blvd., South Bend, IN 46601. <br />http:/fwww.st osephcountyindiamcom/depattments/SJCHP/indexhtm <br />p: 574-235-9798 f•. 574-235-9578 e: SMCHPC(a cost-jjoseph.in.us <br />OFFICEUSEO+NLrij»>,>}DONOT„C NM FTZLANXYNIBZ CdNTA1N DtNTHisBOX«««OFFICE'USEONLY <br />11 <br />Date Received: i� • ` • ! Application Number. 2 O 12 I I <br />Past Reviews: ❑ YES (OWrofZWRe kw) ❑ NO <br />StsffApproval authorized by: Title: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark ® Local Historic District(NmO _TA(Z1M Q±r V' <br />❑ . National Landmark ❑ National Register District (Nast) <br />Certificate of AppZTDftculed <br />ass: ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />R <br />tease Print) <br />ssodress of Property for proposed work: 5,,.?.�.__, c�•i:�- <br />/ (Street Number—'Street Name—Ci(y-Code) <br />Name of Property Owner(s): `atmF�i C i� Phone #: <br />Address of Property Owner(i): '�.,,•�/I �nt3Yri <br />(Street Number—Street Name—Clo—Zip Code) <br />Name of Contractor(:): 4; Ie�- 1 t?1YZt..i;Y e,,, Phone #: <br />Contract Company Name: <br />Address of Contract Company: <br />(Street Number— Street Name—City—Zip Code) <br />Current Use of Building: c�►`nGj� , 1�� <br />(Single Eandjy:; Wa--�Famik—Commercial—Govern rent Industrial =Vacan(-etc) <br />Type of Building Construction: <br />X11 /A -f�P1'It'-�� <br />✓(Wood Frame—Brick--Stone—Steel—Concrete—aher)' <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: ` Q���'� , <br />Owner/Contractor Fax #: <br />(&qt%will Corr ate` :ly-one designee) <br />X <br />, Signature of 0 e <br />email: q ods Pa;vn0- �?,,grna I. corn <br />and/or X <br />Signature of Contractor <br />n <br />