Laserfiche WebLink
Application <br />-FOR- <br />Certificate <br />FOR- <br />Cern icate ofAppropriateness <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http://www.stj osephcountyindiana.com/depariments/SJCB P/index.htm <br />p: 574-235-9798 f. 574-235-9578 e: SBSJCHPC(a,co.st-joseph.in-us <br />OFFICE USE ONLY>»»>DO NOT COMPLETE ANY ENTRIES CONTATNED IIV TffiS BOX «««OFFICE USE ONLY <br />Date Received: 119131q Application Number: oMA,9 — 0:06,00 <br />Past Reviews: �YES (oarsofLauReW-)- ' ❑ NO <br />Staff Approval authorized by: / ' Title: .t ,(� <br />kte&ict, <br />Historic Preservation Commission Review Date: �% <br />❑ Local Landmark Local Historic District (N=4(is:.11a-4 � l"• <br />❑ National Landmark ® National Register District (Name,) <br />Certificate of Appropriateness: , <br />❑ Denied ❑ Tabled ❑ Seat To Committee ® Approved and issued: <br />(Please Print) P Y proposed �V�Q(/ ' <br />Address of Property for osed ro work: &,,,I <br />S ec�Q 1117/_ <br />(Street Number— Street Name--City—Zip Code, <br />wner(s) <br />Name of Property O: k"o te r� Phone <br />Address of Property Owner(s): _ 7J "i'o rf_S;4- &C-0 I <br />(Street Number—Street Name—City—Zip) �tg <br />az <br />Name of Contrartor(s): b8a �i- Phon46d,, acs —® `7 <br />Contract Company Name: &I It, I <br />Address of Contract Company: VIM 4-1 <br />(Street NuYmber— Street Name—Ci Zip Code <br />Current Use of Building: i U..e� -�✓ <br />((Single F y—Multi-Family--Cont%ercial—Government—Industrial—Vacant—etc.) <br />Type of Building Construction: e(►� O <br />(Wood Frame Brick—Stone- Steel--Concrete—Other) <br />Proposed Work: P n)"Kind ❑ Landscape ❑ New ❑ Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked <br />Description of Proposed� <br />Wo ._ • Gr V,, Gro -o <br />ivl r-ou r -�Oo a i-c?o - lr :93,5 <br />t <br />Owner/Contractor Fax #:. e-mail: /) <br />(Staff will correspond with only one designee) <br />X and/or X <br />Signature of Owner Si atureC ntractor <br />ADDY Y0ATTnV TOTi nTT1UV..MF.NTc ARF. T.TCTR:TI m uRVY.RCF. CTAF <br />