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C41 ar <br />Application fie, _$2 o <br />• FOR- au t 61� <br />Certificate ofAppropriateness nyjj4 <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 v <br />http://www.stj osepheountyindiana.com/departments/SJCBP/index.htm <br />p: 574-235-9798 f: 574-235-9578 e: SBSJCHPC@co.st-joseph.in.us <br />OFFICE USE ONL Yy» >>DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY <br />Date Received: � , I i � _(� `'1 Application Number: <br />2nILA —1-101 <br />Past Reviews: ❑ YES (Date oftast Review) J ❑ NO <br />Staff Approval authorized by: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark <br />❑ National Landmark <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled <br />Title: <br />0 � ���L4 <br />\Local Historic District (Name) <br />National Register District(Name) i t <br />❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) <br />Address of Property for proposed work: flre-, cc <br />(Street Number— Street Name—City—Zip Code) <br />Name of PropertyOwner(s): rad 1r i 1�1 c,c�t „�t..t LLC Phone#: t 0-q$1•-)ZyS <br />Address of PropertyOwner(s): 22OS 'S�'1tcr�t S%rccfl So �#t 66.4 , �wd,a•�• <br />( reet Number— Street Name—City—Zip Code) <br />Name of Contractor(s): R rA d Icy Mc„�tiw,tht L Le <br />Contract Company Name: 9m,,111,4 LLC <br />Phone#: (,3,0- 981'72yr <br />Address of Contract Company: Z Lo S S M.,_A 3 t_- <br />(Street Number— Street Name—City—Zip Code) <br />Current Use of Building: <br />(Single Family—Multi-Family—Commercial—Government—Industrial—Vacant—etc.) <br />Type of Building Construction: <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: guild <br />X,Jc.sm ((��t-IUtlf-t, ) l,sc,..&A ul <br />RLPI Roa T W t 'k ccj.,. �I,,,, <br />Owner/Contractor Fax #: <br />(Staff will correspond with only one designee) <br />X <br />Signature of O r <br />A l 1CA4{c t A- L PIG^• ,1 s� VLN 11, [[ All <br />l�. frriJ AtSk.o,% iN <br />FIclF-vtc///� <br />itrtn+eccl S1r.w� Its �,..tlt wt•h. Aic(,i Itc�ul G1 tr•.[ntto-�( <br />e-mail: '�t •M n rd C, <br />V <br />and/or X <br />Signature of Con4actor <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />