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://www.stj osephcountyindiana.com/departments/SJCHP/index.htm <br />p: 574-235-9798 f 574-235-9578 e: SBSJCHPC@co.st-joseph.in.us <br />OFFICE USEONLP>»»>DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«1««OFFICE USE ONLY <br />Date Received: K'o\j , .s ' LApplication Number: 2N <br />Past Reviews: ❑ YES (Date ojLast Review) ❑ NO <br />Staff Approval authorized by: �I ('� <br />Historic Preservation Commission Review Date: 1 ` ni 1 "L <br />Title: <br />Local Landmark <br />❑ Local Historic District (Name) <br />❑ National Landmark <br />❑ National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled <br />❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) � <br />Address of Property for proposed work: / � 1 ��. t�/;� l `� t" 3 0 <br />(Street Number— Street Name—City—Zi Code) <br />�/1 � 1 <br />Name of Property Owner(s): t!C U,C U, /.E f' ! �I . Phone #: 7 - /,3 57/ <br />Address of Property Owner(s): S(l 61 P <ri 1 Gl � o ✓(J. <br />11 r/ (Street Number— Street Name—City—Zip Code) <br />Name of Contractor(s): 1 (G1 K [A 0 14"a Phone #: , �' 61 93 <br />Contract Company Name: Cf l A S' ()M &ACP LOM 4, <br />�I If <br />Address of Contract Company: a (p ec U m Ro . !V I' l ('S 41-1— vq n o <br />r (Street Amber— Street Name—City—Zip Code) <br />Current Use of Building: S r:'1Gk T' 11 v Lyre <br />(Sinklee/ Family -Multi -Family: Commercial--Government—Industrial—Vacant—etc.) <br />e <br />Type of Building Construction: lh �' i I le /I /".m P <br />(Wood Frame—Brick—Stone—Steel—Concrete—Other) <br />Proposed Work: ❑ In -Kind L21 Landscape ® New ❑ Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) 1 <br />Description of Proposed Work:I iP1 C l /t (�I ✓1 d)Ltt ClC �/Q�(� W l ��t : /�Ptn C�l 60 1 / ( I ij,P <br />Owner/Contractor Fax #: S -7 V- 0 V - Qn2 %, e-mail: hoth 6 Ily f 0 c 0 ✓ r(j St. i1 P I <br />(Staff will correspond with only one designee) <br />X7,,and/or X <br />Signature of Owner Signature of Contractor <br />—APPLICATION RE UIREMENTS ARE LISTED ON REVERSE SIDE— <br />