|
SOUT$�,�� Application A Rk$A 101,1S51pyfRs
<br />-FOR-
<br />,EASE, z Certificate ofApproprlatenesscc ZI:
<br />- y
<br />O b
<br />._ .a HISTORIC PRESERVATION COMMISSION 60 co
<br />„ r 1865 A of SOUTH BEND & ST. JOSEPH COUNTY
<br />125 S. Lafayette Blvd., South Bend, 1N 46601
<br />http://www.stjosephcountyindiana.com/departments/SJCHP/index.htm
<br />p: 574-235-9798 f: 574-235-9578 e: SBSJCBPC@co.st-joseph.in..us
<br />Li.li Id 1111�b1 p1 IIII IIT Il ilii I III 1 h 1,11, III— I I ,, , i 1111 11 1, 111, 1, 11 1 I I III 11 0 111 1 111111 111, 1. 1 1 III 1 11 1 II 1II I II I I III V
<br />OFFICE USE OMLYS»»>DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOil:OFFICE USE ONLY
<br />Date Received: Application Number:
<br />Past Reviews: ❑ YES (nate of Last Review) ❑ NO
<br />Staff Approval authorized by: Title:
<br />Historic Preservation Commission Review Date:
<br />❑ Local Landmark Local Historic District (Name)
<br />❑ National Landmark ❑ National Register District (Name)
<br />Certificate of Appropriateness:
<br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued:
<br />III�II Iui11111Y 11,11b YII II.11ol ilio l,Y11111,11, III Y�IIII
<br />III II11111tl1u1 III IIJI Id1 I II III III All 111 Ilk 11 ,IiulYul11 n1111 iI1111,1111111111111111,111111 ,I I, lip .In 1111 111,1 I,n, hI,Y,11111 II Ii11111111e 11 1 ,,I 1,111,114 111,u1I ,111E 11 illi �I111111111111111111411111 4111 1111111111111111111 II 11 l,ulm�
<br />(Please Print)
<br />Address of Property for proposed work: (Dost R i ve.t"S i'ChL .. S 0,_L-1-vN C-Ss`n3 W 4 1p(0 p r
<br />(Street Number— Street Name- Eih Zip Code)
<br />Name of Property Owner(s): `� �, pP��`�S t --1-L Phone #•
<br />Address of Property Owner(s): Z t YATE.S iL...� _ Mo,., ' P-cs j).le-4 M-1- (XDOE G
<br />(Street Number Street Name—City—Zip Code)
<br />Name of Contractor(s):�p �'e k ' T L'ii S Com- Phone #: --Ii O -'2-Z r 3
<br />Contract Company Name: ?�c
<br />Address of Contract Company: �2-w el 41R -AP -`q LL+ A -v -e- X,p-4-' 2e, &ii ul, xi—
<br />(Street Number— Street Name—City—Zip Code) (4O�
<br />Current Use of Building:
<br />(Single Family=Multi-Family—Commel'cial—Government Industrial—Vacant—etc.)
<br />Type of Building Construction: L,-)e1=�. A
<br />(Wood Frame—Brick—Stone—Steel--Concrete—Other)
<br />Proposed Work:� In -Kind ❑ Landscape ® New 00 Replacement (not in-kind) ❑ Demolition
<br />(more than one box may be checked)
<br />Description of Proposed Work: A- (- "e� _ -
<br />Owner/Contractor Fax#: `1-7-03- (P_4Z4e-mail: St3,,44% b_ -_,I a j)t- � 1+°� �� �=v"'\
<br />(Staff will correspond with only one designee)
<br />X s—�5�' "'.� �-�, and/or X
<br />S C'C' t+. 3 C S C 110-W r^ D11'Gk—
<br />
|