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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, 1N 46601 <br />http://www.stjosephcountyindiana.com/departments/SJCBP/mdex.htm <br />p: 574-235-9798 f. 574-235-9578 e: SBSJCHPC@co.st-josej)h.in.us <br />OFFICE USE ONLPS»»>DO NOT COMPLETE ANY ENTRIES ('ONTAINED IN TATS BOX«««OFFICE USE ONLY <br />Date Received: 7 e%st .201 Application Number: /,1/7 <br />Past Reviews: ErYES (DWe 0fL0& Revteww)),i q� � ❑ NO <br />Staff Approval authorized by: (",[JFX Title: <br />Historic Preservation Commission Review Date: <br />❑Local Landmark3Local Historic District (Name) <br />❑ National Landmark ❑ National Register District (Name) <br />Certificate of Appropriateness: / 7 o20lZ <br />❑ Denied ❑Tabled ❑ Seat To Committee proved and issued: Olct <br />(Please Print) ■ <br />Address of Property for proposed work: 5,/i% �...��• �oSeOti ��"• <br />(Street Number— Street Rame—City—Zip Code) <br />Name of Property Owner(s): '� /Y Phone #: <br />Address of Property Owne'r(s): �/q J . S�. �/QSGD �'! J7�• <br />(Street Nu ber—Street Name—City—Zip Code) <br />Name of Contractor(s): Atki &ISH&d-[OAl Phone #: _,I'1 Si- Y'S -S-- /0 SO <br />Contract Company Name: <br />Address of Contract Company: _�r✓0 •eX W- i' a6er4 .1•n/ A/4,5-54' <br />(Street Number— Street Name—City—Zip Code) <br />k <br />Current Use of Building: <br />(Single Family—Multi-Family—Commercial—Government Industrial—Vacant—etc.) <br />Type of Building Construction: f1 E _60F, <br />(Wood Frame—Brick—Stone—Steel—Concrete—Other) <br />Proposed Work: ❑ In -Kind- ❑ Landscape ❑ New e/Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) f' <br />Description of Proposed Work: Ar, deck W"at I&I <br />. ('hil 1'es . <br />Owner/Contractor Fax #: e-mail: -JjkYED lam_ mi 'ana ho rnE S ey vt <br />(Staff will correspond with only one designee). <br />X and/or X <br />Signature of Owner Signatu f Contractor <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />