Laserfiche WebLink
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.stjosephcount) ndiana.com/departments/SJCHP/index.htin <br />p: 574-235-9798 f: 574-235-9578 e: SBSJCHPC(a,w.st-jose;,3h.in.us <br />OFF/CE USE ONLY»>»>DO NOT COMPLETE ANY ENTRIES CONTAINED IN TH15 BOX«««OFFICE USE OMP <br />Date Received: le C»T. 10/2, Application Number. <br />Past Reviews: ® YES ttweeo/tanaewew/ /�ayja(o - a?r/D.6 ❑ NO 1 <br />Staff Approval authorized by: W /9f Title: zalf/ <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark ©'Local Historic District (Nage) 6zt,rte T<4r , <br />❑ National Landmark ❑r "NationsiRegisterDistrict(Nmo <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee 171A6proved and issued: 11�9 45FCel?�7/Z <br />(Please Print) �'11 1, <br />Address of Property for proposed work: �d 3 gjja r :: A V e �o o Fh N„s i> �AV) <br />"t <br />trees Number Street Name—City—Zip Code) <br />Name of Property Owner(s): �3o kl 11) lq C v j P M P r l.1 S Phone #: 5 7 / - o? 3 3 —fv �?O <br />// I� _ <br />Address of Property Owner(s): to 3 TG r k 1d r v e 5c 11 j3e^' 1 /) �� /b <br />(Street umbeStreet Name—Cily—Zip Code) <br />Name of Contractor(s): / nP "^,-76 re +(f (sem„ 1 Phone #: o?yR - . 3 Q// <br />Contract Company Name: 90 f) N fC l L. 0 ur .4 <br />( U <br />Address of Contract Company: RIO A) /Y' Ct f k\(I I :5-f- ) i-(mrw J T/V '16, <br />(Street Number Street Name---City—Zip Code) <br />Current Use of Building: 5 r),5 %-Q m "I V <br />(Single Famtbx--Mulli-Family—Commercial—Government—Industrial—Vacant—etc) <br />Type of Building Construction: o r.l r /'P } 12 <br />(Wood Frame Brick--Slone—Slee!—Concrete—Other) <br />Proposed Work: In -Kind ❑ Landscape ❑ New ❑ Replacement (not in-kind ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: ear <br />rP l i G C L - t r-n'J i <br />s �N iw X 7' <br />eke Jr wC«l <br />I <br />Owner/Contractor Fax #: <br />(Staff will correspond with only one designee) <br />X <br />Signature of Owner <br />C)') slj)e wCAI k Ari)) <br />of X `/a wiDf- <br />aPjn X 3` rn ,ys OfT n4 <br />/ <br />e-mail: rOjrVN\i f ije-k 101 40 //IAnv .tool <br />and/or X <br />Sa ture of Contractor <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />