Laserfiche WebLink
(4/2/2013) Page <br />Cine Hostetler - sjchpc lrz 1.pdf '---' <br />ather1 <br />12COAApplicaUon.pdf <br />hitp://www.stjosephcountyindiana.can/departments/SJCHP/coah <br />Application <br />-FOR- <br />Certificate ofAppropriateness <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd, South Bend, IN 46601 <br />http://www.stjw phcountyindWmr.om/dcpwtmexttsMCHPftndex.htm <br />p: 574-235-9798 f: 574-235-9578 e: SBSjCHpC@co.st-josephin.us. .. <br />OFFICE USE ONLY»»»DO NOT COM}I A11Y ENTRIES COMAIKED m 7itt5liOX««ccOFF7CE USE ONLY <br />Date Received: Ad4_ Application Number. aW 3 — 0#40 2— <br />P sst <br />Past Reviews: ❑ YES (o roeJtm x Wer) ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark Goal Historic District (ivr) <br />❑ National Landmark ❑ National Register Dbtrict(x er) <br />Certificate of Appropriateness: , <br />❑ Denied11Tabled ElTabledTo Committee pproved and issued:LLJ <br />(Please Print)• /� / <br />Address of Property for proposed work: • v �(,'A''A �/ S© 4f 6, i% 1 <br />(Stred Number— Street Name—City—Zip Code) /' Q <br />Name of Property Owner(s): LA, <br />�/%t'` R, t '� � ,/Phone <br />#: �! " �U S" q7� Z <br />Address of Property Owner(s): ;5'1'7 /N IV/A/ Avo{_ S6 4-44e 7l <br />/) & (Street Number—Soret Name—City—Zip Code) /� n <br />Name of Coutractor(s): N v z_FA _ ����1� Phone fl: 1i3 G— `1co <br />Contract Company Name: -7��� /f �[ , )�,,,r , j �/ <br />Address of Contract Company: Z$ZC G 7, t &wool a-G� N e L �N `o,557 <br />(Street Number—Street Name—City—Zip Code) i <br />Current Use of Building. C w -�'nSr� / <br />(Singe Family—Multi-Family--Com»i&/al— overnment—Industrial—Vacant—etc.) <br />Type of Building Construction: WVV C) ` (vVl Com — <br />(Wood Frame—Brick—Stone—Slee)- ('oncrete—Other) <br />Proposed Work: [Bin -Kind [2 LUndsape ❑ New ❑ Replacement (not in-kind) ❑ Demolition <br />(more than one bar may be checked) <br />f firn- D�- l�,au-�cr <br />Description of Proposed Work: <br />hc <br />I <br />IS <br />tai t1 izu -cuss ru <br />Owner/Contractor Fax Z3 2'— �i7 e-mail: <br />(Staff w! correspond wtth only one designee) <br />X �/1/ \ and/or <br />i.of 3 Signature of Owner <br />I. <br />Kmx- % 4xio +r ex- C@ 2z� ( - laft1 <br />X <br />Signature of Contactor <br />vu <br />rt-uxt to /V SA <br />ifj�_ <br />a�- <br />4/1/13 9:17 F <br />