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i <br />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.stj osephcountyindiana.com/departments/SJCHP/index.htm <br />p: 574-235-9798 f: 574-235-9578 e: SBSJCHPC@co.st-joseph.in.us <br />OFFICE USE O/)NLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFF/CE USE ONLY <br />Date Received: OC -2 1%4d. CeV1,J Application Number: c46/3 — /.Wj <br />Past Reviews: ❑ YES (Date of Lan Review) ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark <br />❑ Local Historic District (Name) <br />❑ National Landmark <br />❑ National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled <br />❑ Sent To Committee ❑ Approved and issued: <br />Please Print A 01 <br />Address of Property for proposed work: i 703 %0(7C)4I C -le MY- --Y?t,t4A 5)11 t<_/ 6, <br />(Street NtAber— Street Name—City—Zip Code) <br />Name of Property Owner(s): �- J % �_ - Phone #: <br />Address of Property Owner(s): <br />-� (Street Number— Street Name—Ci(y—Zip Code) <br />Name of Contractor(s): 3 40 'n' r u_ r 4- U r^tom Phone #: t�;9 _ 7-2 L 2 i ) <br />Contract Company Name: , c> A rr) /r <br />Address of Contract Company: _A-1 6(_1 , Se, .eA6? vi <br />C� <br />(Street Number— Street Name—Ch)Zip Code) <br />Current Use of Building: / -,, j f-, jj t,r"_c> VVI �r /' 4�/ cL/ <br />(Single Family—Multi-Fa y—Commercial—Government—Industrial—Vacant—etc.) <br />Type of Building Construction: ,ia1 r r e-Z�J/ C,;_ (^ (:) LZJ -A- <br />(Wood <br />A(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: ��s--� _ , r -L) 1, A <br />C -li = `i r� f.✓ rM r* t f . lei r r /1 s� d l...n e� r� r) v JC7�.'.i7 f �f fir r <br />Tiltryy t..c � �/' d r J 1!5h'gin /1,a i111(A' c, f.•_It,�7 t� `7 C.` Y,r-t;t_ '_d <br />i�ty n�� , Gctp�=CPU <br />Owner/Contractor Fax #: �Z 5,j p, .;) 4; Cy I e-mail: <br />(Staff ivill correspond with only one designee) <br />r <br />1 , <br />X Q l'vts ��t �t7 �;tt'!� and/or X <br />Signature of Owner Signature of Contractor <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />