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SouTHB� Application <br />�0 �111111iii,i//, -FOR- <br />����� Certificate ofAppropriateness <br />Appropriateness <br />HISTORIC PRESERVATION CONMISSION <br />1865 of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http://www.stj osephcountyindiana.com/departments/SJCB P/index.htm <br />p: 574-235-9798 E. 574-235-9578 e: SBSJCBPC@co.st-joseph.in.us <br />OFFICE USE ONLPS»»>DO NOT COMPLETE ANY ENTRIES CONTAINED IN TEIIS BOX« («<�«OF-T7CE USE ONLY <br />Date Received:i�i��t Application Number:�� <br />Past Reviews: ❑ YES (Date of Lag Review) ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark <br />❑ National Landmark <br />Certificate of Appropriateness: <br />❑ Denied Tabled <br />(Please Print) <br />Address of Property for proposed work: <br />/� /� f <br />Local Historic District (Name) �`' pn 1!/��(11,� n <br />❑ National Register District (Na—) <br />❑ Sent To Committee ❑ Approved and issued: <br />90(o GG(arzd <br />(Street Number— Street Name--City—Zip Code) <br />Name of Property Owner(s): -I-c7 &n T*) ow n 5 Phone #: 5-4i- 2 P 4 - D SS g <br />Address of Property Owner(s): $ N q j7b r r s+- A j i. S v v A - ti (3 ,e n d IN L/ (d6 (�a <br />(Street Number— Street Name—City—Zip Code) <br />Name of Contractor(s): 4a 6 e dr- d tr n" . n c d Phone #: <br />Contract Company Name: ('not 5,0 r c. _C 14- of S 1+a w , ..tit r A tr Lla,7s, c r N e - d C, rc cn <br />Address of Contract Company: <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: a s I'h t A o r a.. r. A+ I. "10 <br />' (Wood Frame Brick--Stone--Steel—Concrete—Other) <br />Proposed Work: ❑ In -Kind JeCj Landscape 9,New ❑ Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked <br />Description of Proposed Work: 1 n s u r a n e e, Ga r,n io a n 7 t 5 Cb c 4 a¢, n g r a+ ). n g .01 <br />-}ire t Bnr-k S-1-airS a ,eeft es+f <br />fi kcr a r44trs n a O-Aelen <br />Owner/Contractor Fax #: e-mail: <br />(Staff will correspond with only one designee) <br />X /', -- 0 o and/or X <br />Signatu(e of Owner Signature of Contractor <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />