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Application <br />-FOR- <br />Certif Cate 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.stjosepheountyindiana.com/departments/SJCBP/index.htm <br />p: 574-235-9798 f. 574-235-9578 e: SBSJCBPC@co.st-josephJn.us <br />OFFICE USE ONLY- - ­DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX— ­—OFFICE USE ONLY <br />Date Received: 07'ae/,4 Application Number:lry� — t77d 7 <br />Past Reviews: r QQQQ8YES (DateojLastRevlew) /,3 7Z" 4QD-Z ❑ 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 />Eg <br />r <br />Local Historic District (Name) /-Y- /cC� <br />❑ National Register District (Name) <br />❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) <br />Address of Property for proposed work: 1 et :1, o G- (w 1 A-LitJ i= ST SOUTH 6EIVZ) 4 iv 4 6(d I e; - I e e4 b <br />(Street Number— Street Name--City—Zip Code) <br />Name of Property Owner(s): h/'A Nc'_(f l c..KLGk & &A -RLI 14AMAU R & Phone #: (q?4) �2 (. f --5170 <br />Address of Property Owner(s): 11+'23o f tAf f-lin/ F< i )<� 0 v i t4 .REN l IN 44 G (7 i 5-- (U y 0 <br />(Street Number— Street Name—Ci�ip Code) <br />Name of Contractor(s): 'f'C- IF F K C SS L_ R , Phone #:S*7 <br />Cg) 1516-3611 <br />Contract Company Name: -rr-VT ' -, i -k7) M E 1 M pv C1 / e AA C- ,N <br />i <br />Address of Contract Company: 5 X 1 5 Ilok iG Rb S t3 u.7 -H 43 E K/ 17 1 I k) 4% / L4 <br />(Street Rumber— Street Name--City—Zip Code) <br />Current Use of Building: 5i nt m -c- FFAM i L! j (4-"Mr- <br />(Single <br />-FnMr-(Single Family—Multi-Family—Commercial—Government—Industrial—Vacant—etc.) <br />Type of Building Construction: PO A AA t= S i U C e O <br />(Wood Frame—Brick—Stone—Steel—Concrete—Other) <br />Proposed Work: ❑ In -Kind 11 Landscape ❑New ❑Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: SC -1= A-1 T/VC1-4 CjD <br />Owner/Contractor Fax #: !V t7 N e-mail: Ylekln <br />(Staff will correspond with only one designee) <br />X and/or X '3 C�,,��}LL,W <br />ti` <br />