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06/02/2014 MON 15:31 PAX 1 574 647 3195 MHSB 5SE n <br />U001/001 III' <br />E <br />so TO Application <br />-FOR- <br />Certificate of Appropriat mess <br />ti ''� � � -x� HISTORIC PRESERVATION COMMISSION <br />1865 of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http://www.st osephcountyindiana.com/departments/SJCHPfindex.him <br />p: 574-235-9798 f 574.235.9578 e: S13SJC14PC@a co.st joseph.iri.us <br />V, ....'l'i II.. .e. . ., 1. iI .tri Nr .iia 1111, I , i u dd luIDoN u., i i ni.in 1 _. .n. 1...n ui. 11 . .n 1 . .1 <br />OFFICF USF. ONLr>»>»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS =-=t-«OFFICE UStIONLY <br />Date Received: Application Number: <br />t <br />Past Reviews: ' 2YES tD4re0f1ArRakNJ 3i he NO <br />Swrf Approval authorized by: Title: <br />Historic Prescrvstion Commission Review nate: <br />❑ Local Landmark Local Historic District (Name) <br />❑ National Landmark ❑ National RcgistcrDistrict(N4m4 <br />Certificate of IAppropristeness: _ <br />❑ Denied ❑ Tabled ❑ Sent To Committee j- j Approved 2. -Ad 4,nied: <br />I.kI.&II ..0 ,..i.,iny.�eu Win�uikiu:Lali.nmi i. i ..n i ..ia ..I uu w,dns.tlLdeb .Il a!i. ■.grinan,t rl.. rr u.a+rrw <br />(Please Print) <br />Address of Property for proposer! work: � Q� W N ��? ��� ��- � �� �� �• 1 � � <br />(Street Number— Street Name--City--zip Core) <br />Name of Property Owner(s): !chi t c rT�c T�Q S . (It l tri Phone 9.1 <br />Address of Property Owner(s): ? `i c.J � J` l k�Y1-1 )YL .'Stix= I 'Z , I N q lo(A <br />(Street Number— Street Name—City—•Zip Code) <br />Name of Contractor(s): C5 Ln— IFf> Phone #: <br />Contract Company Name; <br />Address of Contract Company: _ _ <br />(Street Number— Street Name-amity—lip Ccde) <br />Current Use of Building: St"t-rk�LL-q <br />(Single Family—Multi-Comily—Commercial—Goverrur:enr--Industrial—Vacant—etc.) <br />Type of Building Construction: W Gel TVP -1" L _ (W I-rA 1312i LIZ- r—�,N-OA-n bN 'AT- <br />(Wood Frame—Brick—Stor:e--Yeel--Con:reie--Otacr) <br />Proposed Work: ❑ In -Kind K71 Landscape ❑ New ❑ Replacement (not in-kind) ❑ Demolition <br />(inure than one box may be checked) <br />DescriptionofPro pas edWorit: Pi1CI,�O {`t'1ko, 1^� UyIt-�% V Lb -3 M P,L» PST <br />��1/�2� t.4 wt5i' l'DcxL (' fRt C tawt.5 N�`�c{'✓ pop CA , Doc F•LUwOL ibl oS <br />L e' -V-1_ r7 I Pl'Y2 t%'n�t�31 til S /h fes] N US�eLS -- �L UT�i C� i� t�ir Wim. il AJ <br />�t3 S C!Q OSIS /I(' L'r7-i.-rsvy� t.t; I A,V ry ; a A t S 1 Iry tr] l� l P <br />Owner/Contractor Fax e-mail: 1,P i Cj i t�L-,ll e�5 1.�j ctln �•C_ <br />(Staff will cc espond with only one designee) <br />X r �,�'(---^�- _ and/or X <br />Siguatt r(idowner Signature of Contractor <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />