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r. <br />Application <br />-FOR - <br />v iy <br />Certificate ofAppropriateness <br />HISTORIC PRESERVATION COMMISSION <br />1865 of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http:// www .stjosephcountyindiana.com/depm tments /SJCHP /index.htm <br />p: 574- 235 -9798 f: 574- 235 -9578 e: SBSJCHPC@,co.st-josephJn.us <br />iJii I. ui iii I i i i i ■ <br />OFFICE USE ONL ri » » >p0 NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX «« «OFFICE USE ONLY <br />Date Received: Application Number: <br />Post Reviews: EYES (Dde of LW Rewew) f ­1V - / c,2 / f ❑ NO <br />Staff Approval authorized by: / Title: <br />Historic Preservation Commission Review Date: <br />cal Landmark <br />❑ National Landmark <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled <br />(Please Print) <br />Address of Property for proposed work: <br />Name of Property Owner(s): <br />Local Historic District (Name) -tj- L I r wLe <br />❑ National Register District (Name) <br />❑ Sent To Committee ❑ Approved and issued: <br />■ <br />11.3 7 <br />(Street Number Street Name —City —Zip Code);_"_" <br />Phone #: <br />d _ <br />Address of Property Owner(s): <br />Street Number— Street Name - Ci ' Zi Code - <br />Name of Contractor(s): y6Zta& !) Phone #: <br />Contract Company Name:, <br />Address of Contract Company: <br />(Street Number— Street Name — City —Zip Code) - <br />- rf -.� -__ .x.4.5`` _• - - = T�3. _ - _ -.`<: _ <br />• Current Use of Building- _ -: <br />_ - gle F ily —Mul - Family— Commercial — Government — Industrial Vacant —etc.) >. - <br />Type of Building Construction: yi <br />(Wood Frame—Brick—Stone--Steel—Concrete—Other) <br />Proposed Work: ❑ In -Kind ❑ Landscape ❑ New ,Replacement (not in -kind) ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: �� �i»GR.tJ,Fi .fl�etfJ <br />y6 Ar .c��x�f11�l.�EaL2 , d = .%y./ !i`fid`� <br />Owner /Cont Fax #: e -mail: <br />(Staff will cond with nly one des' ee),_ - r <br />X and/or X <br />Signature o Owner Signature of Contractor <br />A DDT T9 -A1T V nTTTVrUr.NTC ARF T.TCTY.1101412F. .RCF. CTT)F <br />