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Application <br />-FOR - <br />�`' Certificate of Appropriateness <br />w �.EA�E j,'% y <br />Ie rte_ ';x a HISTORIC PRESERVATION COMMISSION <br />1865 of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http://www.stj osephcountyindiana.com/departments/SJCHP/index.htm <br />p: 574-235-9798 f. 574-235-9578 e: SBSJCHPC@co.st-joseph.in.us <br />+VIII Ills iil li III 111.1111 II 111111 u. I...... .1111 I11111 iYI 10111111111 ills l u YII Ii11III 1im.-11.1.1.1 YYIIYIIiI iIIYLIIIIWYW1WWIl Y— A W I Ilit.—Will iiI.1111uY�11,. 1111 I I IWYWYfII.I11.I"mill, Mi— Ii11111 YIIIdI IWI.iIIIIIII� I�iii dim l <br />OFFICE USE ONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY <br />Date Received: -3 Application Number: 494/0 <br />Past Reviews: YES <br />Staff Approval authorized by: <br />(Date ojLast Review) <br />7 <br />'U <br />Historic Preservation Commission Review Date: <br />❑✓ Local Landmark Local Historic District (Name) <br />❑ National Landmark ational Register District (Name) <br />❑ NO <br />Title: f <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committeepproved and issued: /IA011I <br />1 1 1 I I III 11 ■ <br />(Please Print) &.l%'j/ <br />Address of Property for proposed work: �� ��/ j UL��"�' %&" <br />(Street Number— Street Name—City—Zip Code) ' <br />Name of Property Owner(s): L S (L( ftk­ v`' r��� Phone #: J�`7 l —2�' <br />Address of Property Owner(s): J twu i C. -,b') V;?—(V ` <br />(Street Number— Street pe—NCity—Zip Code) <br />Name of Contractor(s): J ��}�/[ S�`�"1 D'Z(� Phone #: <br />"I,%A <br />6 <br />Contract Company Name: <br />Address of Contract Company: J (aq <br />(Street Number— Street Name—City—Zip Code) <br />Current Use of Building: ii/�G 1`'94ft <br />(Single Family Multi-Famil)—Commercial—Government—Industrial—Vacant—etc.) <br />Type of Building Construction: <br />(Wood Frame—Brick—Stone—Steel—Concrete—Other) <br />Proposed Work:In-Kind ❑ Landscape 11New❑ Replacement (not in-kind) ❑ Demolition <br />(more than one box m b checked) <br />Description of Proposed Work: "l vK r t&k fir",4 <br />�l <br />Owner/Contractor e-mail: c �' (4�rvc act <br />(Staff will corres nd wi h only o 6 st <br />X and/or X <br />