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May. 6.2014 3:34PM <br />Application <br />-FOR- <br />Ceilificate ofAppropriateness <br />No, 0140 P. 1 <br />Nu� <br />HISTORIC PRESERVATION COMMISSION of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S, Lafayette Blvd., South Bend, IN 46601 <br />http://ww-%v.stjosephoountyindiana.com/departments, SJCHP/index.htm <br />p_ 574-235-9798 f• 574-235-9578 e: SBSJC$PCCco.st joseph-in-us <br />+A II11 1YI IIII IIII„I .1. 1111II II 1: -1 11I II 1 1 ,i: I I I 1i IIII III , 11 1". I: I Al I I U1 .. II 1h. W . : --.- <br />OFFICE <br />I -.I:,OFFICE USE 0A1r-�,,q;->>RQ NQT CQfvrPLLTE ANY ENTM8 CQNTAINED nv TH1 M---<<OFF10E USE ONLY <br />Date Received: Application Number: _ <br />PastReview6. ❑ YES (bareofL&aRtruw) ❑ NG <br />Staff Approval authorized by: Titin: _ <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark ❑ Local Historic District (Nano <br />❑ National Landmark ❑ Nation &I Register District (Na m) <br />Certificate of Appro nateness: <br />Lj Denied ❑ Tabled ❑ Sent To Committee ❑ Approved atsd issued: <br />X1110. �Illd In111 IllrI IIIIIYI 111I111�:1IIIIII nY11h.InIIr1CIIGYCYY11YlYY„�hYJI 111,11111 11 I I, 111I,u IYI.Irk.ilrllell.Jllla,l,rul�d..rrr: '--. uII I: ,,rndl, I,.,, ,.Icclu,Yl <br />(Please Print) <br />Address of Property for proposed work: fJ �it�►,�eict9�10N <br />(Street NumberaL Street Name--City--Zp Cade) �1 <br />Name of Property Owner(s); I� t&��... — r f Phone #: 57'`>f�/ �fl,� <br />Address of Property Owner(s): c227 Al. t' �d1eY.. Bly W+ O -Tt) ` VAL1 J <br />/ V LV J' �r (Street Number— Street Name-City—Zap Co,*) <br />Name of Contractor(s): '�i� / A — ti>yQi.&phone#: <br />e <br />Contract Company Name: <br />Address of Contract Company: <br />^' (Street Number` Street Name -City -Z� Code) <br />Current Use of Building: �falE .. 4k►r"`- <br />(Sin-gle�+Famil)-Multi.Famll ommRal—Government—Industrial—Vacant—etc.) <br />'Type of Building Construction: ORW <br />ood Frame Bric�4 Orl¢`ZSt¢¢1—COt�T£tE—OthBY) <br />Proposed Work: In -Kind ❑ J..aodscepe ❑ New ❑ Replacement (not in-kind) ❑ IDemolitioa <br />(►none than one box maybe checked) <br />Description of proposed Work: <br />YM.QAa�r. 0 0 9. Qi aaCLIti. t- <br />Owner/Contractor Fax #: 51Lat "J - 55T5 e-mail: j Il4f(11' t�1 IJ <br />(Staff wil*ovner <br />Aoneeslgn:e)X ptj A`j� and/or X -_- - <br />SignaturSignature of Contractor <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />