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Application <br />-FOR - <br />Certificate of Appropriateness <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http:// www. stjosephcountyindiana .cbm/departments /SJCBP /index.htm <br />p: 574- 235 -9798 f: 574- 235 -9578 e: SBSJCBPC@co.st-joseph.in.us <br />OFFICE USE i� »DO NOT / COMPLETE ANY ENTRIES CONTAINED IN THIS BOX «« «OFFICE USE ONLY <br />Date Received: l 7"'�'` ° /7' Application Number: .2ff 1 <br />Past Reviews: 2 (Date oftast Review) 7d66 '/ o2D/ z ❑ NO <br />6F <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: 0: <br />❑ Local Landmark FVLocal Historic District (Name) e. 0a4 -6 Yn "-t <br />❑ National Landmark F1 National Register District (Name) U <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) <br />Address of Property for proposed work: - r WOV O C \50 -A \ D b, I A 0 4&6 <br />�A ! <br />(Street Number— Street Name — City —Zip Code) / <br />Name of Property Owner(s): ��,{�i I �f S Y�rC �'SYPIY Phone #: 5 `f ` Z33 23 2 Q <br />Address of Property Owner ( s): , <br />P ( ) 1 /- Q� , ( lX.�i1 �►2 ��(,C � cw' . oL� t) U l5 <br />( Street Number— Street Name — City —Zip Code) <br />Name of Contractor(s): — Bru c L IA / 1 l bcDl Phone #: <br />Contract Company Name: '1�aym1 Ayfck O ve r q- N Y l r aic , I vii. <br />N i� - <br />Address of Contract Company: o��PO d "� ►"� �(� N I `iq) av <br />�^ ( (Street Number— Street Name — City —Zip Code) <br />Current Use of Building: `> yla le 't I <br />(Sine Family — Multi -Fa ily— Commercial -- Government — Industrial — Vacant —etc.) F. <br />Type of Building Construction: (1 l (,, �Y1, Yl 1104 ,�� (�� (� '� vv (l � �. (P'6/yj� q- �� jl k- <br />4 (Wood Frame Brick— Stone— Steel —C ' o t n ' cr re ete— Other) <br />Proposed Work: ❑ In -Kind Landscape New <br />Replacement (not in -kind ❑ Demolition <br />(more than one box may be checked <br />Description of Proposed Work: P^� 'nTviS 3 whkh ( wc and CUI - ) DOO �oli q GZY� <br />11 O,�I 11 urYl -N2 A,S 6' ) 40 lnP r eP10 -CM - \�A 1 agkrd in -Uc, <br />e i* h�, l � � �)vn P a i n ylkvs . <br />`, j <br />using A 1 i+MecSfiU� e lc�c�k M me , 4(} s --oY?e <br />Owner /Contractor Fax #: e-mail: d y i�1,n (iljY1/1 c"t, yjP t <br />(Staff will correspond with only one designee) — <br />X � � (� {'Ld & and/or X <br />Signature of Owner v Signature of Contractor <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />