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N - <br />A $Cir Certificate ofAppropriateness <br />- HISTORIC PRESERVATION COMMISSION <br />1865 of SOUTH BEND & ST. JOSEP11 COUNTY <br />125 S. Lafavette Blvd., South Bend IN 46601 <br />http://www.stjosephcountyindiana.com/departments/SJCHPrindex.httn <br />p: 574-235-9798 f. 574-235-9578 e. SBSJCHPC@co.st-joseph.in.us <br />OFFICE USE OVLF>>>>>>I)0 NOT CONITLEn, ANY ENTRIES CoNTj D IT 0X<<<<<<OFF1C6 USE ONLY <br />Date Received: 4� a,44_ Application Number: C41 13 fl 74 f, <br />Post Reviews: YES (Date PfLastxmew) 4 A NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: <br />. . ........... <br />Er Local Landmark EJ Local Historic District ovm) <br />National Landmark National Register District ame) <br />Certificate of Appropriateness: <br />Denied n Tabled ❑ Sent To Committee Approved and Issued: <br />(Please Print) <br />Address of Prop" for proposed work: <br />(Street Number— tName—City—Op Code) <br />Name of Property Owner(s): &ef" <br />,t\ Phone fl: <br />ISS ? <br />Address of Property Owner(s): V L/� <br />(Stree) Number `Street Name—City—Zip Code) <br />Name of Contractor(s): j 4,ortylft Phone ft: <br />Contract Company Name: <br />Address of Contract Company; <br />(Street Number— Street Name - -City —Zip Code) <br />• Current Use of Building: P! I A <br />' (Single 1 <br />Type of Building Construction: <br />(TYcodFrame—Brick--,Stone—,9ect—Concrele—Other) <br />E] Replacement (not in-kind) <br />Proposed Work: In-Kind ElLandscape Q"New Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: f <br />3 <br />Owner/Contrictor Fax 0: erMi)n Jt4L,'P(;; ) <br />Z b 6 ?/ <br />7 <br />(Staff will correspond with only one designee) 19 <br />X� C41 and/or X <br />Signature of Owner Signature of Contractor <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />