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;T <br />•f �s °' T' e eti Application cow�,s °`°errs <br />_ pfyGirti - FOR - z <br />Certificate ofAppropriateness <br />HISTORIC PRESERVATION COMMISSION <br />racs of SOUTH BEND & ST. JOSEPH COUNTY p� <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />httpJ /www.st osephcomrfindiana .coni/depamnents/SJCIiplxndex.htm <br />p: 574 - 235 -9798 f. 574- 235 -9578 e: SBSICHPC@co.stjosephJn.us <br />OFFICEUSEONGPb> DO NOTf'OM ET aNY NTRiP aoocac <br />Date Reeeived: AppEealloa Number. d u es _ Qp le '3 A <br />Pas, Reviews: ❑ YES rpmyt.erto: 1 ❑ NO <br />Staff Approval authorized by: Tide; <br />Historic Preserntlon Contrubsiun Review Data.. <br />Local Landmark Lmai Historic District plan, <br />National Landmark Nadooal Register District siv r) <br />Certificate ofAppropr ateoess: <br />Denied 0 Tabled [] Sent To Committee [] Approved and blued: <br />Address or Property for proposed work: J A V"_ <br />(r ._ ( / �weet , N /, ym / ¢wStreet Nome— City —Op Code) —/� p <br />Name ofProperty Osrner(s): Vet -SQ7'1 //�.7�/� 1�s tt Phone#:J 3 — tel <br />Address of Property Owuer(s): s% �Gt /(! Ae 6D /✓s° 8 / 4 1& (V& <br />i r ��ff l (Street Number— StreelName— Ciry--Llp Code) 9 �)�/ <br />Nameof Centractor(s): t+ei\� 7 Phone#: S7 Y, 9 /' ` G� <br />,Q <br />Contract Company Name: F r k <br />Address of Contract Company: <br />( Str�ee Number StreetN eery —Ztp de) <br />Current Use of Building: 5/ I / `t Oa'f. e - t/ <br />(Sing! tly— Muftt- Fermi(7�Camneercl�— Government— )ndustrla(— Vacant —efe.J <br />Type of Building Construction: <br />(WaodFmme Brick Stone — Sleet— Canwete-0rher) <br />Proposed Work E] In -Kind �I,andscape ❑ New Replacement(not in -kind 13 Demolition <br />(morethanoneboxmaybechecked) 9 v <br />Descriptio of Propozc, L lJl� 1 � y� � <br />�[ rfh Ltn d('! t �l rtn la L� AWA- AAim a 1 4. .m+ <br />t.t-t t_%J OKI" <br />Owner /Contractor Faxlf: e-mail: / <br />(Sw fsvi(( correVo svidh anti, one designee) <br />N ia and/or X Z <br />turpner gi <br />r — APPLICATION REQUIREMENTS ARE LIS7tD ON REVERS SIDE- <br />0. <br />