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May.25. 2012 11:45AM Midland Engineering <br />Application. <br />FOR. <br />Certificate of Appropriateness <br />H7(STOAfC PRESMVATION COM USSYON <br />* ism • of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayctte Blvd., South Bend, TN 46601 <br />httpJ/www.stjosephcountyindim&conVdepartTnents/SICHP/index.htin <br />p: $74-235-9798 P 574235-9578 e: SBSJCHPCC@co.st joseph.in-us <br />ol'nm USEONLY>>>>>>00 NOT cohX .SrE ANV 2a= CON rAV(M IN TM B0X««<<0FFTCE USEMY <br />Date lteceived: aS ?y a"t, jot °Z Application Number. o2G �e2 S 2 S <br />- u <br />-Past Reviews: 9YES tVmgfLawXntew) ❑ NO <br />Staff Approval authorized by: Title: /&M,44D <br />Watotie Preservation Commission Review Date: <br />❑ Local Landmark ® Local Historic District ( sw ) <br />❑ National Landmark ❑ National Register DistriettN.wr) <br />No. 4620 P. 2 <br />Certille$to of Appropriateness: <br />❑ Denied ❑Tabled ❑ Sent To Committee � pp roveJ and issued: Z <br />(Please prim) <br />Address of Property for proposed work: �r <br />dl IE� Jaj c► r r.-. <br />(Soret Number- StreetNmne-City-Zip Code) <br />Name of Property Owner(s): Phone #: -74 f S So'7 6C]6�j <br />Address of PropertyOwner(s): of ►-��Jarre 151L. <br />(Street Number- Street NWW-City-Zrp Corte) <br />Name of Contractor(s): t""` I S � Ir- Phone # .- <br />N rt <br />Contract Company Name: <br />Address of Contract Company: <br />(Stred Number-- Street Name—City—Op Code) <br />Current Use of Building: 5-(1 <br />(Srngl� �,nily—Mu1t�Fami ommerciaC—Governme�a� 1'ndusrrial-1'✓acant—etc) <br />'type of Building Construction: w"3 J <br />(Wood Frame�Brick r -Stance -Steel- �or:crete- Other) <br />Proposed Work: ? W -Kind ❑ Landscape ❑ New ;Replacement (not in-kr4 �molitioh <br />(more than one bar may be checked) <br />Description of Proposed Work: i C-ct r F'�"4i <br />�.�� <br />Owner/Contractor Fax #: s7`7 —a'7A ''-7Y,04) a -mail: <br />(Staff will co and ►vrth only one e) <br />54 <br />fit-�' 5�' t� 131 <br />r.l('fes $ 6c. 2 nce, <br />cwt Corte <br />X and/or X <br />Signature o[Owner Signature of Contractor <br />AADr A nV:- c•tun <br />Ak <br />P <br />