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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 .com/departments /SJCHP /index.htm <br />p: 574- 235 -9798 f. 574- 235 -9578 e: SBSJCHPC@co.st-josephJn.us <br />OFFICE USE ONLY» » »DO N`�OT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX « < < / FFICE USE ONLY <br />Date Received: cg� 4 , 01 , 9 6 Application Number: d cp — 6 / ,d <br />Past Reviews: ❑ YES (Date offfftReview)�' /� ❑ NO <br />Staff Approval authorized by: I w) A t ertztit) Title: <br />Historic Preservation Commission Review Date: <br />7 <br />Local Landmark ❑ Local Historic District (Name) <br />❑ National Landmark ❑ National Register District (Name) <br />Certificate of Appropriateness: —/ / s� <br />❑ Denied ❑ Tabled ❑ Sent To Committee �pproved and issued: �l� <br />(Please Print) n , / f� / L1 <br />l5 <br />Address of Property for proposed work: 24 C A 14VIt �� f I A 7 j <br />� <br />(Street Number— Street Name --City —Zip Code)`' l j 2 <br />Name of Property Owner(s): c � CCs d - n j I � le.dJ e,r ? r Phone #: J �'7 363 '"1P 13 3 <br />Address of Property Owner(s): ,,DL"c V -P <br />(Street Number— Street Name -- City —Zip Code) <br />Name of Contractor(s): O �-� Phone #: <br />TZ <br />Contract Company Name: V , :� ©l�f .lLf .t/ j:ze4 * 16 7 <br />Address of Contract Company: <br />� Street Name --City —Zip Code) <br />Current Use of Building: ,nn, : rVV\ <br />- ?Single Famir Multi - Family -- Commercial — Government — Industrial — Vacant —etc.) <br />Type of Building Construction: �.(� tz A _ <br />(Wood Frame — Brick — Stone -- Steel — Concrete — Other) <br />Proposed Work: ❑ In -Kind ❑ Landscape ❑ New ❑ Replacement (not in -kind) Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: 9"LL'ut l� �. ,� -� P /1 �Aj e <br />c <br />Owner/ ntractor Fax #: <br />(Staff wil correspond with only one designee) <br />X <br />Signature o;4� er <br />o 1) L/ l e L/j <br />e -mail: j_r"_ �'�F' T \ !� @C <br />and /or X <br />Signature of Contractor <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />