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-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 />littp://Www.stiosephcountyindiana.coin/departin , ents/SJCHP/index.htm <br />p: 574-235-9798 f. 574-235-9578 e: SBSJCI-IPC@co.st-joseph.in.us; <br />OFFICE UVEO,'VLV>>>>>>D0 NOT COMPUTE ANY ENTRIPS CONTAINM MITTS BOX— ­—OFFICE USE ONLY <br />01 <br />Date Received: r"T- 1 I Application Number. <br />1-&— 0 _ I— k 1-1 <br />Past Reviews: YES (&it of tastmeae.) cl,, 7� 0 n NO <br />Staff Approval authorized by: <br />Title: <br />Historic Preservation Commission Review Date: _0 i , __? _r(, V7 <br />EJ Local Landmark M l,ocaillisturicDi.-,trict(,)vomr)S��N *,, Vo,-�L, <br />IA I <br />E] National Landmark EJ National Register District (Ivamr) <br />Certificate of Appropriateness: <br />EJ Denied <br />❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />---------- Ai <br />(Please Print) <br />Address of Property for proposed work: 4 r" <br />(Street jN"umber— Street name--City—Zip Code) <br />Name of Property Owner(s): 9 'L <br />Address of Property Owner(s); r3 rr, <br />(Street Number— Street Name--City—Zip Code) <br />Name of Contractor(s): A T,= Phone U�' <br />Contract Company Name: r- f 3 I t` r7 f f1r, <br />Address of Contract Company: A r" f* /N) t) 7L 4 <br />(Streel Number --Street Name---City—tip Code) <br />Current Use of Building: <br />(Single Fami13 Afulti-Family—C'olnmercial-Coverttment—industrial—Vacant—etc.) <br />C,- <br />Type of Building Construction: I " A MZ <br />O-VoodFrani e—Brick—,Stotie—Steel--Coticrele—Otlier) <br />Proposed Work: [%n -Kind ❑ Landscape ❑ New ❑ Replacement (not in-kind) ❑ Demolition <br />(inore than one box may be checked) <br />Description of Proposed Work: T_ -ell 5� <br />hhh <br />Owner/Contractor Fax 4: e-mail: <br />(Skiff will correSpol id with only one designee) f'' Ise <br />X and/or P', <br />Signature of Owner Signatu� e of Contractor <br />i <br />—APPLICATION REQUIREMENTS ARE LINED ON REVERSE SIDE— <br />