Laserfiche WebLink
Application <br />-FOR - <br />Certificate of Appropriateness <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, M 46601 <br />http: /hvww.stj osephcountyindiana .comfdepartments /SJCHP /index.htm <br />p: 574- 235 -9798 f. 574- 235 -9578 e: SBSJCHPC@co.st-joseph.in.us <br />OFFICE USE O,VLY» OT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX « «< ., . <br />`l 1 » >DO 1S < <O USE ONLY <br />Date Received: I I� \ � I 1 1 L_1_)j-D Application Number: L ") 1�_) — �n` -t 1 <br />Past Reviews: ❑ YES (Date oJLast Review) <br />Staff Approval authorized by: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark <br />❑ National Landmark <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled <br />FMM <br />Title: <br />d Local Historic District (Name) <br />❑ National Register District (,Name) <br />❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) n _ <br />Address of Property for proposed work: S 7 /V /G wiz S 10/2 )D2— c v) <br />(Street Number— Street Name— City —Zip Code) S 7 } <br />Name of Property Owner(s): Lp /22 i^ /-1 ,t / L Phone #: <br />Address of Property Owner(s): /-?')-, > 1 //,S i2 S J 9i , 2 1 — / � � J�I� 1i14 I <br />(Street Number— Street Name — City — Code) <br />Name of Contractor(s): C 7 y-- Phone #• <br />Contract Company Name: lq U (2 N <br />Address of Contract Company: 6 fz n ! % /'� %� �- I✓ 7GL ^�� <br />` (Street Number— Street Name —Cit) —Zip Code) <br />Current Use of Building: ..J % ', "; � 1 " /L ( r <br />(Single Family— Mztlti- Family— Commercial— Government— Inditstrial— Vacant —etc.) <br />Type of Building Construction: �/f'lL% 12 () o .C- <br />(G4'ood Fran:e— Brick — Stone -- Steel— Concrete — Other) <br />Proposed Work: ❑ In -Kind ❑ Landscape ❑ New -Replacement (not in -kind) ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: _ p)- 4- r i / l- x ,Q CCSL_ //I t 2C e- F= t /V <br />7 7 r7 R- 2 K) 7 <br />JLt �1 �� �HN�y �� j�S SC1if <br />IAIS, C- 7 6_4QI <br />Owner /Contractor Fax #: e-mail: <br />(Staff tivill correspond with only one st nee) <br />X �l.!1.��1 /_ i� �L - ��! l and /or X � <br />Sr* fu' to of O�v r 1 Si ature of Contractor <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />