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 />http://www.stjosepheountyindiana.com/departments/SJCHP/index.htm <br />P: 574-235-9798 f: 574-235-9578 e: SBSJCH?C@C0.st.jose])h.in.us <br />OFFICE USE ONLri»»>DO NOT COMPLETE ANY ENTRIES CONTAIlVED IN THIS BOX«««OFFICE USE ONLY <br />Date Received: ,13 Application Number: o&4& <br />Past Reviews: nIVES (D&egfLiWRe*w) ❑ NO <br />Staff Approval authorized by: /'{ Tide: _Jtuell� <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark rM Local Historic District (Name) <br />❑ National Landmark ® National Register District (Name) <br />Certificate of Appro rlateness: <br />Denied ❑ Tabled ❑ Sent To Committee ® Approved and issued: ;�K- 020/ i <br />(Please Print) �l ��-• <br />Address of Property for proposed work: �v3 T�i.44 �a?• Se uy���D <br />(Street Number—Street Name—City—Zip Code Name of Property Owner(s): c,..� Itar� Phone4?08i '70 <br />Address of Property Owner(s): T�sf su . u`i-� ,Q 4&(101 <br />(Street Number—Street Name—C%0p Code) <br />ire <br />Name of Contractor(s): Phone #: <br />Contract Company Name: <br />Address of Contract Company: AA /ars O <br />(Street Number— Street Name—CI 40 Code <br />Current Use of Building: i ��/ <br />(Single Fq y Multt-Family—Conilnercial—Government—lndustrial—Vacant—etc.) <br />Type of Building Construction: <br />(Wood Frame—Brick—Stone—Steel—Concrete--Other) <br />Proposed Work: Kind E]Landscape ❑ New E]Replacement (not in-kind ❑Demolition <br />(more than one box may be checked <br />Description of Proposed Wo fi..ry Q+9y q0. t �.•�►'� <br />I <br />Owner/Contractor Fax #:. e-mail: <br />(Staff will correspond with only one designee) <br />X and/or <br />Signature of Owner <br />S1 stare C utractor <br />