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N <br />.A,IJpIICaOIl <br />-for-. <br />Certificate. -of Appropriateness" <br />Historic Preservation Commission of South Bend & St. Joseph County, . <br />227 West Jefferson Blvd - RM 1123 pouth Bend IN, 46601-1830 <br />Phone: 219-Z35-9798 FaX:219-235-9578. a -mall: historiCkSunirmana.org <br />A Certified Local Government <br />OFFICE USE ONM—>»DO NOT COMPLETE An EMMMS CONTAINED IN THIS 2OR«««OFF7C8 USIi 0Nmr <br />9Z l <br />Date Reeefve 2J A It20 _ -_ -- Aopntatlon Number 3 - <br />Past Reviews: YES . (D MOJFUantrirI� NO <br />Zonint Type:. Lot Shm . <br />Staff Approval authorfzed by: Title! <br />Mstorle Commission Rbvfevi Date: <br />Wrotionst <br />1�cal Landmark ' National <br />'La/nd 7ut <br />Register District (n.;4, <br />❑ Local Historic Dl*ddet PI -4: <br />CertHieate of Appropriateness: <br />Denied a Tabled F1 Sent To Cotamfttee . <br />Approved and issued f �� 20 f <br />Address of Property for proposed work: Leeper-�- <br />SewtMmMonAsoeaNmmJ <br />City: C-,oA IVA. Township: <br />Name of Propet•ty Owner(s):trwm C•,1 0� So..�t• Qc••� Q�rut <br />Address of Property Owner; 'val.. E W41Lcr <br />Contractors) Name: C of 5a��ti+ Vicryl Putt <br />Contract Company Name: <br />Contractor Address: City: <br />Contractor's Phone No: Owner's Phone No: <br />Current Use of Baliding: d nv c•^ <br />-(ftkFmnf*-MeaFFowly-Cammerdat-Gorannew-/adafeie -Vacant-de <br />Type of Building Construction:. <br />(baudPam - Brick - Stem -SW-Comcwt-001e ) <br />Proposed Work: F1 Inkind Landscape New n Replacementpett"n.9 <br />(nore than ane box may he dweba) - <br />F1 Demolition (Completion of 9everate Form Also Reanired) <br />Description of Proposed Work: bee- diu-,W Mrs 4 paper <br />Owner/Contractor: Fax: e=tnailio^�ipSO Sou�.�tt� 60J <br />PUT oof ee 11011 conv mud with only ane drrigne,) <br />Signature of Owner Signature of Contractor <br />APPLICATION REQUIREMENTS ARE LISTED 6N REVERSE SIDE - <br />Any and aR business of this office fs handled via a-mdR and fax with leastpreferenee to U.S. Mail <br />• 'r <br />.. <br />4. <br />'t. <br />