Laserfiche WebLink
SOUTIiBF Application r`pµM�S510Nfq� <br />d�- FOR <br />Certificate .of Appropriateness <br />HISTORIC PRESERVATION COMMISSION °o 0 <br />i 1865 # of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http://www.stjosephcountyindiana.com/departments/SJCHP/index.htm <br />p: 574-235-9798 f: 574-235-9578 e: SBSJCHPC@,co.st-joseph.in.us <br />OFFICE USE ONLI>»»>DO NOT COMPLETE ANY ENTRIES CONTA NFD IN THIS BOX«««OFFICE USE ONLY <br />Date Received: _—L)5,201,3 Application Number: 0101.3 <br />Past Reviews: YES (Dare ofLW Xe'*W) it ` 0�0 /.3 ❑ NO <br />Staff Approval authorized by: A/y Title: <br />Historic Preservation Commission Review Date: p <br />❑ Local Landmark19ocal Historic District (Name) <br />Lr` <br />❑ National Landmark F54ational Register District (Nano <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee 214proved and issued: u - <br />(Please Print) <br />Address of Property for proposed work:,e ,,- <br />(Street Nu er—Street Name ity—Zip Code) <br />Name of Property Owner(s): • _ Phone #: <br />Address of Property Owner(s): <br />(Street Number— Street Name—City—Zip Code) <br />Name of Coutractor(s): ,Jl l Phone #: <br />Contract Company Name: <br />Address of Contract Company: <br />(Street Number— Street Name--City--Zip Code) <br />t <br />• Current Use of Building: <br />(Sin& Family—Multi-Fami ommercial---Government Industrial—Vacant—etc.) <br />Type of Building Construction: <br />�— <br />(Wood Frame—Brick—Stone—Steel—Concrete—Other) <br />Proposed Work: In -Kind ❑ Landscape ❑ New ❑ Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: kLant (M in rj 101- AU <br />AMa <br />Cie 9 <br />Owner/Contractor Fax #: e-mail: <br />(Staff will correspond with only one designee) <br />X and/or X J <br />Signature of Owner Signature of Contractor <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />