Laserfiche WebLink
Application G��M,Sbiory fps <br />- FOR - <br />vf:ACt � s� <br />j E,;, 2 Certificate ofAppropriateness <br />Appropriateness <br />� � ro <br />HISTORIC PRESERVATION COMMISSION <br />y 7865 a of SOUTH SEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http:/hinvw.stjoseplicountyindiana.con idepartmentsiSJCHP/index.htm <br />p: 574-235-9798 " f: 574-235-9578 e: S13SJCHPC@co.st-joseph.in.us. . <br />OFFICE USE 0NLY»»»n0 NOT COMPLETE XVY ENTRIES CONTAINED IN THIS BO\«««OFFICE LISEOh'LY <br />Date Received: lee &e C oW /Z ;application Number: 40/Z — 1,91(a <br />Past Reviews: ❑ YES (VfdeafLartRevten) © NO /� <br />Staff Approval authorized by: (�(J/9' ' Title: A4_1aicf_-) <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark Local Historic District (Mfm_) - <br />❑ \ational Landmark ©' National RegisterDistrict (vamm) 11-latI6 <br />Certificate of Appropriateness: o2a/ <br />F-1Drnied ElTabled❑ Sent To Committee PlApproved and issued: 1lv &&t <br />(Please Print) <br />Address of Property for Proposed work: ,Job UlI1?()nte, ��rl¢ ^ itce 9C)_fh jI lle?U�1I <br />t <br />(Srre`et�Yumber—Streeillrame—Cit}- ZfpCode} <br />r1 <br />Name of Property Owner(s): ( ' ,.5 (r h L� G'�t�71?ef Phone#: <br />Address of PropertyOwner(s): <br />Ali <br />Number— Street Name—City—Zip Code) <br />Name of Contractor(s): Ali (Z)n.Stru & Dn Phone #: r9 <br />Contract Company Name: <br />Address o I Contract Company: <br />f (Street wumbert-Street Name—City—Zip Code) <br />Current Use of Building: &Petr' FPtoll <br />14Single Family—Mttlti-Family—Commercial—Government—Inditstrial—natant—etc.) <br />Type of Building Construction: 1 A ,, <br />(Wood Frame—Brick—Stone Steel—Concrete—Otlrer) <br />Proposed Work: ❑ In-Kind ❑ Landscape ❑ New F q�Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) a <br />Description of Proposed Work. T_ f�arof-� ,�¢lftl<!L'S. 1r) 1 of d l kY;D eciPe I ilGL%erl <br />t,5- 1f e r,J <br />C L) inrK tri -rlt.Sh ( a h .n av� Sj P S <br />Owner/Contractor Fax 9: e-mail: CDI,,P f rvl CI�Dh L AC'Mobe I -n 0-'7 ` <br />(Staffivill correspond with only one designee) <br />X and/or X /ltt/��',{GI,� /'J` i Coss q ih <br />Signature of Owner Signatur4of Contractor <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE- <br />6'd 0VZt't Z917L9 6uiJooB 19 uoi3ona3suo0 ry 13175:L0 Z 6 9 6 300 <br />