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Application. <br />-FOR- <br />Certificate ofAppropriateness <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND & ST. JOSEPH COUNTY . <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http://www.stjosephcountyindiana.com/departments/SJCHP/index.htm <br />p: 574-235-9798 f. 574-235-9578 e: SBSJCHPC@co.st joseph.in.us <br />OFFICE USE ONL iy»»>DO NOT COMPLETE ANY ENTRIES CONTAINED IN THiS BOX«««OFFICE USE ONLY <br />Date Received: 3� a��a- Application Number. 0241 . — /ate <br />Past Reviews: ❑ YES (Dau ojtad Revkw) <br />Staff Approval authorized by: <br />❑ NO <br />Title: <br />Historic Preservation Commission Review Date: / % %%B cl'• 020 ! Z <br />❑ Local Landmark® Local Historic District (None) <br />U <br />❑ National Landmark ❑ National Register District (Name) <br />Certificate of Appropriateness: <br />❑ DeniedElTabled F1Sent To Committee ❑ Approved and issued: <br />(Please Print) ,��5 �, , j �G <br />Address of Property for proposed work: A� 1)(/ q 6-c O t <br />(Street Number— Street Name—City--Zip Code) <br />C <br />Name of Property Owner(s): �q �' � mCar-ItI V .. Phone N: �-6 7� <br />Address of PropertyOwner(s): s� S• �d=rif J oSP!'� S'• (� [C6_0 I <br />(Street Number— Street Name—Cit)—Zip Code) <br />Name of Contractor(s): <br />J ee�m "Qve-&, Phone #: <br />Contract Company Name: <br />Address of Contract Company: <br />(Street Number— Street Name--City—Zip Code) <br />Current Use of Building: �1 <br />(Single Familj M— -Famil ommercial—Government Industrial—Vacant—etc.) <br />Type of Building Construction: _--� <br />ood Frame— rick--Stone—Steel—Concrete—Other) <br />Proposed Work: ❑ In -Kind ❑ Landscape ❑ New ❑ Replacement (not in-kind Demolition <br />(more than one box may be checked n ` 0, / 1�, <br />Description of Proposed Work: R,e ore. `�""'"t`L `L �e i(//�rCt'+ ��S f�dr�1�"`L�YOnc.�r2'e�'r. <br />i r'/vr^b%%►� ; re,ol�re a� fir ; ss;nv alapbo�r'o�-� /"�s�ore /Tar 74a-ecc& <br />Owner/Contractor Fax #: <br />(Staff will correspond wilh only one designee) <br />X� -. <br />Signature of Owner <br />e-mail: �� CC�� / ��i'C CJ <br />Car - <br />and/or X <br />Signature of Contractor <br />