Laserfiche WebLink
4 sO UT11 - Application ytQMIAISS10ryEq� <br />-FOR- <br />o �. <br />Vol r o . <br />:: \FACT %1 Ce6 �r{r� LvILCt� lei 0 App op bW�v fVt his& s :; �� �t.�r;b <br />`t .a HISTORIC PRESERVATION COMMISSION m o' x <br />Is65 of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http:// www. stjosephcountyindiana .com/departments /SJCHP /index.htin <br />p: 574- 235 -9798 f: 574- 235 -9578 e: SBSJCHPC(@,co.st-joseph.in.us <br />OFFICE USE + ONLY» » »DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX «««OFFICE USE ONLY <br />Date Received: ��z� r3 Application Number: .1? <br />Past Reviews: [g S (Date of tart R-iew) �I see 6 L, ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: /�.J 13 <br />❑Local Landmark Local Historic District (Name) </I r(. (I, e <br />❑ National Landmark ❑ National Register District (Name) <br />Certificate of Appropriateness: <br />i ❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />= iud. 0a,i..i511oio.Wd�rsLi4lilY.lif Ildli it i i i i i i i i ii II li i i— <br />:- Print) r �. <br />ddress of Property for proposed work: Z Ve_r - <br />-- -- Street Number — Street Name—Ci Zi Code <br />Name of Property Owner(s): � �a :� �..n r> e* ,�� Phone #: 2 — c f C1 L� <br />Address of Property Owner(s): 5143 �.+-; — 1(4 <br />i N <br />(Street Number— Street Name — City —Zip Code) <br />Name - of Contractor(s): n wr j <br />Contract Company Name: <br />Address of Contract Company: <br />Phone #: <br />- Street Number— Street Name —Ci ' Zi Code <br />Current Use of Building: —�—frt v)%�(� AJ y <br />Single Fami ly— Mul! - Family — Commercial -- Government — Industrial — Vacant —etc.) <br />:Type of Building Construction;. <br />(Wood Frame Brick— Stone — Steel — Concrete —Other) <br />Proposed Work: ❑ In -Find andscape ❑ New ❑Replacement (not in -kind) ❑ Demolition <br />(more than one box may be checked) = - - •- ' " -'' <br />Description of Proposed Work: ""JZL 1 t q rl �ecv' -KAT <br />9 <br />r A r� (il1Q.t ': k 4a <br />oo I — 0S 1 ( � 0 a <br />`� <br />p� /�/� anti, ivl � (�tYYL�r.Ai 0 61S <br />- <br />c \'`4 1'�l �Valy 1 1 N � r _ - ' `..-_ 11', 56A *X1 +-- tom... 6' 4,0 t&U ` <br />Yin - �v S ova $e�eo�.l <br />Owner /Contractor Fax # J� e -mail: <br />(Sta(f 'll correspond vith only one designee) _ <br />X _ .,i/./r✓��i�'�� and /or X <br />S gnature o ner ` / Signature of Contractor <br />