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Certificate ofAppropriateness <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND &.ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd South Bi-nd IN 46601 <br />http://xvww.stjoseplicountyindiana-coin/departmenWSJCIJ.Pliiidex.htm <br />p: 574-235-9798 t- 574-235-9578 e: SBSJCIIPC(q?co.st-josepli.in.tis <br />OFFICE V.TEONL I =—>> DO -NOTCON I PIKIT ANY ENTRIES CoNTAINTI) IN T[ I IS BOX­OFFICE USEONLY <br />Dato Received: <br />Past Reviews: YES (Date of LastRevie),) <br />Staff Approval authorized by: <br />Application Number: _o&_/_3— 11z1,;7,4 <br />Title: <br />historic Preservation Commission Review Date: A? ` 1- ZO 43 <br />. . ........ I- <br />F4;;t' <br />Uj Local Landmark ❑ Local historic District (.ame) <br />E] National Landmark ❑ National Register District <br />Certificate of Appropriateness: <br />U Denied ❑ Tabled ❑ Sent To Committee El Approved and issued: <br />(Please Print) <br />Address of Property for proposed work: 7 <br />Szanbet— Street Natnc—Qv—Zip Co <br />t ree A' <br />Name of Property Owner(s): hone #:,5 -2Y- 2 <br />Address of Property Owner(s): (1617il <br />(Street Number Street Nanic—Ciij—Zip Code) <br />Name of Contractorq(s): Phone #: <br />Contract Company Name: <br />Address of Contract Company: <br />Current Use of Building: (3 051rewt Numher Street Aatm—Cily—Zip COCA) <br />(Single <br />Type of Building Construction: 6,C) 0 �) l .) (Mood <br />Proposed Work- R In -Kind ElLandscape New R Replacement (nal in-kind) Ej Demolition <br />(more thatz one bear may be checked) <br />Description of Proposed Work:/X/ <br />c, <br />Owner/Contractor Fax #: <br />Skis <br />u:auorrespon I Willi my r ne , igix—i <br />Sign ure of Owner <br />...,,;--and/or X <br />Signature of Contractor <br />