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J�. <br />Application <br />-FOR- <br />Certificate <br />FOR- <br />Certi icate -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-joseph.in.us <br />OFFICE USE ONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY <br />Date Received: 1, ,201,3 Application Number: Q�`� — I6.12`1F <br />Past Reviews: ❑ YES (Date of Last Review) ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark dLocal Historic District (Nacre) 0\ -NO, V�'1 0-C <br />❑ National Landmark ❑ National Register District (New) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) t-� �, <br />Address of Property for proposed work: (11 R re<� a n u P, sv �! I a� 1 . <br />Name of Property Owners}: 1 <br />(Street Number— Street 'Name—City—Zip Code) l I <br />s•/a ren Ain514,P v 6 Tim ii} G sL�� Phone #: 574 -2g,f - 4105 <br />Address of Property Owners): <br />S 0 fill' /Srab�Y�. <br />(Street Number— Street Name—City—Zip Code) <br />Name of Contractors): �� t 1 �} Phone #: J� /7 <br />Contract Company Name: <br />Address of Contract Company: <br />Current Use of Building: <br />R l Gk.e' 061154 Ct, 6n <br />1 VV 1 I d w` CreP k- Dr vb MMIka. _-D14 4t 5*6 <br />(Street Number— Street Name—City—Zip Code) t <br />I,n I -e 4a ry,i lq <br />(Single FamiV—Multi-Family—Commercial--Government—Industrial—Vacant—etc.) <br />Wood f�amg- <br />(Wood Frame Brick--Stone--Steel--Concrete--Other) <br />Type of Building Construction: <br />Proposed Work: gin -Kind ❑ Landscape ❑ New ❑ Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: rj 1fl %¢ mia? �� =' 1 �� � � ���4 "'t'qn e �� <br />r h k i r yl !~ e rf-' 1 a 1�1� ta, spm v � r vu ad Inil n .fta�vs, <br />-� rr ;�e�1�Ct✓ rl r in i t', an� <br />1 o 5a.5 i-�- . r ec-t- +be- ih Y7or trim -,vyl <br />+he exten or as z)rahce -the how_' i ( n�'.-% <br />Owner/Contractor Fax #: e-mail: hnnd rw4-6r'10 sbc o ba! t <br />(Staff will correspond with only one designee) <br />X Va"ij41, C . (.414' and/or X <br />Signature of Owner Signature of Contractor <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />