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Appfica on <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 />UfAling Address: Cbl ti' Buitding, South Bend, Indiana AW1 <br />Phone: 574-23 fM * Fax: 574-235-95'78 Etrtzd-S13Sj'CFEC&O-st josePlUmus <br />Websites httr//wwwsqosephcotmVh diana.corn/*hp/index.tiW <br />OFFICE USE ONLY»,>>> DO NOT COMPLETE ANYENTRM CONFINED IN THIS BOX ">" DFE7CE USE O <br />NLY <br />Date Received Application Number -/Z <br />-r tJ <br />Past Reviews: 'YES (Dokoit a xewmi NO <br />Staff Approval authorized by: Title: <br />Historic Commiss€ori Review Date: <br />O Local Landmark Local Historic District (Non ) <br />[] National Landmark 0 National Register District Ovate) <br />Certificate of Appropriateness: <br />E] Denied rl 7hbled E] Sent 7b Committee 0 Approved and Issued <br />VAra <br />NNW <br />Address of Property for proposed work. "i t' �s�"t <br />,t tyummber Start N /� <br />Name of Property Owner(s): Oum Print) _ � `'�'� !;'(e s <br />� <br />7 <br />Address of Property Own ec s .. � .. � '� •`°� <br />Contractor(s) Name: ---r� Cets <br />Contract Company Name: }} <br />Contractor <br />City: ` ,- � Q/�� � Phone: <br />Current Use of Bu3lding ej : z5v <br />Singte.l�anu7y— ut#�Fa+�mlty— -+Cerner:tmert#-»lnut�#riat—y#sarn#—t#c.� <br />'Pype of Building Construction: <br />(Wood fnmrr — Srir7c — — Sten# — Conad e - Mir) <br />Proposed Work: [] In-kind ❑ Landscape New XReplacement (not in-u"d) [1 Demolition <br />(nvi than om bar preybe dusshzl) <br />Description of Proposed Work: <br />fj jffj <br />Owneri/dq�traetor: , l#" . e-mail .!? <br />U a . <br />7-APPLICA7TO REQUIRE fE M ARE US= ON REVERSE SIDE -- <br />