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Application <br />.FOR- <br />Certiftcate ofAppropriamitess <br />HItfFORICFRESEBVA,TION <br />COMMON <br />Of SOUTH BEPW dt ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd, South Bend 1N 46(,Ql <br />httpi/wwwjgowphcountykdiuLcom/dep mneaWsiCUPrmdex.Wm <br />574-235-9798 f:574.235-9576 • e: SBS7CH ?Ww.st joaeph m <br />Date Received: IS "?fir"' X1313 <br />PastReviamr: RYES 00,00"00 <br />StaffApproW autborind by: <br />Uktorie Pc imistion Commhsfoa Rovkw Date: <br />❑ .L adLandm ark <br />' ❑ xatbsud Landmark <br />Certificate otAppro riateness: <br />D,led ❑ Tabled <br />Appikstion ?(umber: 401.3 — JIIS <br />/9 [] NO <br />Title: <br />o 13 <br />tLo=IHJitorIcDhWCtp6q <br />❑ KatlaaatRegfsGerDhMctinta� • <br />❑ SentTo Committee ❑ Apposed ad issued: <br />(Pleare Prino <br />AddressofProperty for prop'ased work: <br />(Street Number- Street Name-Cfp Code) <br />Name of Property Owners): 1' w "- � t,) A) Phone tl: <br />Address of Property Owner(e): <br />Piet Number ---Sheet Nam -City--4 Code) <br />Name of Contmetor(s): %C� D Q ao Al <br />Contract Company Name: l C_ ,ti I PAI AI «x S "i" f�.a p'� a J41j 1v .I)eq IV r <br />Address of Contract Company: <br />(Sftet Number- Street Nang--City-Dp Code) <br />• Current Use of Building: �� �' J1 �' <br />(S7ngk Fami(y-Wil Family-conanmW-Gar me*4 di�Vacant--ct Q <br />Type of Building Conrtruetton: <br />(Wood Pig me-Brick-SYone-SYeel-Concrete-0ther) <br />Proposed Work: ❑ In -Kidd ❑ Landscape ❑ New `.191scement (not in-JElt4. ❑ Demolition <br />(more than one box may be checked) <br />Descriptfots of Proposed Work: fl �' � t� �" f'� I� fl A/ 1,),-) �' ��/v J-) <br />Owner/Contractor Fax #: - e-mail: <br />(Stowill correspond with only one designee) <br />X andtor X <br />Signature of Owner SlgnatureofCongactor <br />APPLICATION REQUIREMENTS ARE IdSTED ON RWMSE SIDE- <br />