Laserfiche WebLink
Application <br />-FOR- <br />Certificate of Appropriateness <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />httpV/www.stjosephcountyindiana.com/departments/SICHP/mdex.htm <br />p: 574-235-9798 f: 574-235-9578 e: SBSJCHPC@co.st-joseph.in.us <br />OFFICE USE ONLY,.->mDO NOT QQHMK ANumpmsni3OX«««omcr USE ONLY <br />Date Received: 14.: G . vzo l3 Application Number. -20 /-3 — 06 03 <br />Past Reviews: YES (Dareojlnrrtev:ew) ❑ NO <br />Staff Approval authorized by: Tide: <br />Historic Preservation Commission Review Date: 17 <br />❑ Local Landmark Lee al Historic District (Name) <br />❑ National Landmark ❑ National Register District (N-4 <br />Certificate ofAppro riateness: <br />Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) <br />Address of Property for proposed work: C55 Rnf6_1eS( 6 dA-. , Soul*- 04A, ?-4 <br />(Street Number Street Name—City—Zip Code) <br />Name of Property Owner(s): )faq r MA04L-A Phone <br />Address of Property Owner(s): 53 6 Ali6n-S t o b2 • t <ouiw 564, �l . <br />(Street Number—Street Name—City—Zip Code) l <br />Name of Contractor(s): 40AIA1 r 6 J 0,99$ &OLI Phone #(S -?d 3fd., 32-58 <br />Contract Company Name: Al Zm4 v_j <br />Address of Contract Company: t77991 e4gwsmtJae ( A4A•16gE �bSS�f- <br />(Street NumbStreet Name—C10�ip Code) <br />• Current Use of Building: 614, it: � 1 tat <br />`-Single Fam!O&LMuld-Famlly—Commercial--Govemment--lndusidal—Vacant—etc.) <br />Type of Building Construction: tdooh rd**6 <br />(Wood Frame—Brick—Stone—Steel—Concrete—Other) <br />Proposed Work: ❑ In -Kind ❑ Landscape IS New' ❑ Replacement (not in-ldm4 ❑ Demolition <br />(more thein one box may be checked <br />Description of Proposed Work: A66n-1aj T 9&A -A erF Akvf6 <br />Owner/Contractor Fax #: e-mail: <br />(Staff will correspond with only one designee) <br />X �I Avll '+— and/or X — <br />Signature ¢f Owner Signature of Contractor <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />