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Application <br />- FOR - <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />Mailing Address: County -City Building, South Bend, Indiana 46601 <br />Phone: 574235-9798 • Fax: 574-235-9578 • Email: SBSJCHPCQcost joseph.in.us <br />Website: http://www.sgbsephcountyMdiana.com/s chp/index html <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES COMMINED IN THIS BOX »»» OFFICE USE ONLY - <br />Date Received Old <br />Past Reviews: [2f'Y'ES (Date of last Review) <br />Staff Approval authorized by: <br />Historic Commission Review Date: <br />Application Number oZO /cZ- - 030.5 <br />.'r 020 U k E] NO <br />Title: <br />Local Landmark Eg-6o cal Historic District (Name) S'0 • at - <br />National Landmark [:] National Register District (Name) <br />Certificate of Appropriateness: <br />F] Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and Issued <br />DATE <br />Address of Property for proposed work: 12- 2 3 f5aS+, Lug Vh,e 611 n2-� 604R, <br />, <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) �O e MiGa �(� 1 PY��C2 h�! Q <br />Address of Property Owner(s): 5 Q <br />Contractor(s) Name: M& 1 fn Miller <br />Contract Company Name: i&l <br />Contractor Address: (1 L i0.-.,-1�1)6�i" 000 M vr--t, <br />City: M i l 1 •.WAj Phone: 2-bq —30q q <br />Current Use of Building: Is 1 V 17° . '- iVt l IV/ <br />(Single Family — Multi -Family — Commercial — Government — Industrial — Vacant — etc.) <br />Type of Building Constructi ~ fl � IZ'3'1 w w 1' �( _5 <br />buo 1+ y n�p 1-- an- _ C w p o (Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: E] In-kind Landscape New. Replacement (not in-kind)] Demolition <br />(more than one box may be checked) , r7 <br />Description of Proposed Work -.7k) f A `7 l ub r ne ki o W o7i n P•w (j),(l/I w- <br />�a(d-e Ltcs�- 4 w eP- W i rtj m S , AtO I Is h-Fr�y►-t c�Q lily <br />2dt-V-- /,t eCV- — rif �(Jl d &C' w i -1'h 64 -me' 1 �nri 61/- ) a - c eme-114- <br />avzj��,-1-t nit - <br />Owner/Contractor. Fax: V 1 r e-mail s <br />(This office will correspond with only one designee) <br />�-'o�X (Q"t.'��� a s • and/or <br />Y <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />