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Ii <br />ntf ;Il, Application <br />FOR <br />N,� ,Certificate ofAp,�rr� riateness COX <br />„^\ �IhkACY, d <br />HISTORIC PRESERVATION COMMISSION s <br />of SOUTH BEND & ST. JOSEPH. COUNTY 'tir ►��� <br />125 S, Lafayette Blvd., South Bend, IN 46601 <br />hitp://%vi,vi r.stjosepheountyiiidiana.conn/departments/SJCHP/indt~x.htm <br />p: 574-235-9798 f: 574-235-9578 c: SBSJClIPCr co.st josephJn.us <br />"uu u01'pIAl41'Yu1 A" I' 'YI,Y "o'u"'oe'111 Y' Y YIiY,ioO'uY 11 " 111,111111 II'mY II 11111,'141.1 '0.11111 IIlIp'pul'IIi 101 1 11111 1 IJO 1I1, a 1''11111 Il l ills 111 llilll l 11 1 YYUY '110'1'.1 ill,' li,dh 1141'1'1 �'u 11111 Ili ilial �lYYllYYll 111 11111111"1111i1'VI1VV1111 I'I�dYU Yu' 111111 III III'1111'I'IY'I'I'I'lll'I'I'IYI'10111uJ 11111 Y'll'I'IYII'1111 YIYIIIYI1,IYu1,I Illui'111. <br />au11,0 ' III <br />F FICF USEOy,VL}>»»>D0 NOT Cf?'l1YI,t',"rF ANY F~ NTRIF:S CONTAINED IN Ti11S BOX---OFFICF. LSEONLY <br />Date Received: C{, 41043 Application Number: c111043 <br />Past Reviews: V1 YES oweafl-adRowew) - ._.._..._....._._................................._._......................._.........._........ ❑ NO <br />Staff Approval authorized by: <br />Historic Pr ervatitm (Co2nwirsion Cteview Date: <br />❑ Local Landmark <br />❑ N atiunal C andnn ark <br />Certificate of Appropriateness: <br />Title: <br />Local Ilistt,ric Di tract 4+4tai <br />❑ Ns6rmaC12e�isicr.C)istrict�a�ae)._.,__._.._._...._....__....__.._...__....._.__ <br />❑ Denied ❑Tabled (" j Sent To Committee ❑ Approved and issued: <br />F-1 <br />14 p141141Vu41111Y11101 II uIU II '14 Y1110101011Y1 II 14111 111,101111111111 1111111111'11111111 14411111111111111 11111111111111 II II 111'1 1 1 II 111 ' Y IIII I'll,' 1'1'1' Y'I' "'p'I"' 1 1'111'1 'I' 11'111111,11.0"11 II 111111 'II T III 11 -hill, II 11'1 <br />(Please Print) <br />Address of Property for proposed work: 3� <br />{Streei`.h'umhetr- AStrret Kane—City--Zip Cixle% r{� <br />Name of Property Owner(s): IU(++ �t Q4LC4T�tlil Sifitk4A 'WCh Phone #: ti •1 ". <br />1 <br />Address ofProperty Owner(s):bu� <br />j . (.Street,tiumbes _. Street ,Fane -City--Zip Ctxle) <br />Name of Contractor(s): �1 1 C # 1tL Phone ti: 51 ` - <br />i <br />Contract Company Name: f� t.�; � � j i vd� v j 4d bcr'r <br />-# ((i �� <br />Address of Contract Company: IL (Ivaft,'h 114 Q � 51 I <br />(Street Number-•- Street Nan:e---00----Zip Code) <br />Current Use of Building:' <br />(Single piarr2ity---,'Multi-f�cur2lty---C,'am»2ercuaJ--Grr��272metlt---Irulutmul--I'acant--ete.,) <br />Type of Building Construction: <br />(iy"arslFrame-. I3rir--.Star2e-.steel- 'or2cre►e -Other) <br />Proposed Work: ❑ .In -Kind ❑ Landscape ❑ .New � .Replaccntcnt (not ire-kirul) ❑ Demolition <br />(mare thmt one box may be checked) <br />Description of Proposed Work: <br />tai 1� il;u(i('7rr1 tsAXi.L;. <br />Owner/Contractor Fax #: <br />(Slaffwill Ccorrespor2rl widtt (mh° one designee) <br />Signature of Owner <br />e-mail: 61- 6W 1, () <br />and/or 1 <br />Signature of Contractor <br />--APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE-- <br />