Laserfiche WebLink
Application <br />-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 />http://www.stiosephcountyindiana.com/departments/SJCHP/index.htm <br />p: 574-235-9798 f 574-235-9578 e: SBSJCHPC@co.st-josephAn.us <br />OFFICE USE ONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY <br />Date Received: �... ( ., . + Application Number: ! - . r k — ✓,: • r <br />Past Reviews: ❑ YES (Date ajLast Review) ❑ NO <br />Staff Approval authorized by: <br />Title: <br />Historic Preservation Commission Review Date: <br />❑ Landmark <br />°, '..... i <br />Local <br />Local Historic District (varve) . <br />❑ National Landmark <br />tt <br />❑ National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled <br />❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) I I n I j,, _ I I' <br />Address of Property for proposed work: `1 v i w I n i) r .rf f a c o4 J Gem i 1-N `1 �101 1p <br />(Street Number— Street Name--Cit)—Zip Code) ! <br />Name of Property Owner(s): � iin n� l / l j�(�p f ►(e Phone #: ?M SCI 6i -- <br />Address of Property Owner(s): 0 ��_ (p'Q( 0( ,�I OVIifwl L'h qq ac) <br />(StreetAmber— Street Name—City--Zip Code) <br />Name of Contractor(s): �) 1 irl�l/�Y 1P r Phone #: llz�1 y <br />Contract Company Name: gl,Sr((X,-ff )wZi3? Cpe_ lu 1)'1 as <br />Address of Contract Company: 59,139 Wn "by & �L� TJ v (16siq <br />(14eet Number— Street Name—City—Zip Code) <br />Current Use of Building: S1 nq4 l C�I 1N <br />(Single Famiil`y—Multi-Family--Commercial—Government—Industrial—Vacant—etc.) <br />Type of Building Construction: �, mcl ' ,IcL L <br />(Wood Frame—Brick—Stone—Steel—Concrete—Other) <br />Proposed Work: TAIIn-Kind ❑ Landscape ❑ New 1-4 Replacements ❑ Demolition <br />(more than one box may hee Aecked()� l `� <br />D cription of Pro ed Work: ►�pVC,(t. �a1(-y1��)1(1Clcu-) . -1-f�S`�'t�`��nCw_��k �S �1C1�� <br />��C1XY11� 1,1inrA[).11 1 J <br />Owner/Contractor Fax #: e-mail: 6swy 4ona <br />c� ►{ omr�S �. t �o t' <br />(StafJ`•will correspond with only one designee) <br />and/or X <br />Signature of Owner �� Signat <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />