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Application <br />- FOR - <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />Mailing Address: County -City Building, South Bend, Indiana 46601 <br />Phone: 574235-9798 • Fax 574-235-9578 • EmaiL• SBSJCHPC@co.st joseph.in.us <br />Website: http://www.stjosepheountyindiana.com/sjchp/ <br />A Certified Local Government <br />OFFICE USE ONLY> »» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received o � Application Number— --- <br />Past Reviews: F-1 YES (Date of Last lzeriew) <br />Staff Approval authorized by: <br />a • <br />Title: <br />Historic Commission Review Date: '901 <br />Local Landmark Ertocal Historic District (Name) -Xi Vef7.,i cAD- <br />❑ National Landmark R National Register District (Name) <br />Certificate of Appropriateness: <br />E] Denied E] Tabled Sent To Committee E] Approved and Issued <br />rQ / DATE <br />Address of Property for proposed work: ! Z � /1 1 Ixe LqI cY e tO:` <br />/ Street Nu ber and Stre t Norrie <br />Name of Property Owner(s): (Please Print) /,. f d 1G I. <br />�P_ :�',ll// <br />Address of Property Owner(s): 'J&/ l��/ S c ct(-e �/' �, .�7� ���c�, /N &4214 <br />Contractor(s) Name: 11 1 Gtt G e/ b(Ar-610 <br />C. r d 114 P. <br />Contract Company Name: A&W -a / ! 10 / r- as"C ,114 C. <br />Contractor Address: 5'75'6 G hq ►-c h m 4,q !i V o <br />City: Al d la vJ Vo A (' ; / /Y 114263 Phone: _ 3 17— 79/ " &e� 73y <br />Current Use of Building: I le- f—la "$'/ V <br />(Single Family - Multi -Family - Commercial - Government - Industrial - Vacant - etc.) <br />Type of Building Construction: f.Q 00 CJ�G� � e- c,,A �T up c G o <br />(Wood Frame – Brick – Stone – Steel – Concrete – Other) <br />Proposed Work: [_1 In-kind E] Landscape E] New Replacement (not in-kind) E] Demolition <br />(more than one box may be checked) % % <br />Description of Proposed Pe m6 v �1 1e, /�oo�r r e 1oa t r Av ,fl - %_tt <br />6114 kIv w el G s & s l o tit i— Gd a4t-1` 44, <br />G1111l djoloea �r /1)(0- -Yfo ^004", <br />Owner/Contractor. Fax: A oh a e-mail-jj* e 1-G L/ 171 l0 %7 C�► e �C� <br />(This officeVwill correspond with only on one esignee)) �— <br />r A /4C ` e / / and/or <br />Signature of Owidr Signature of Contractor <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />