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r <br />Application <br />-FOR - <br />CeMficate ofAppropriateness <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http: / /www.stj osephcountyindiana .com/departments /SJCHP /index.htm <br />p: 574- 235 -9798 f. 574- 235 -9578 e: SBSJCBPC@eo.st-josephAn.us <br />OFHC ONLY---DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX «« «OFFICE USE ONLY <br />� <br />26 <br />0 9 o <br />Date Received: UI U <br />Application Number: <br />— <br />Past Reviews: DIYES (Date of Last Review) /to ' -4AL ZO15 <br />❑ NO <br />Staff Approval authorized by: <br />Title: <br />Historic Preservation C mmission Review Date: <br />Local Landmark <br />Local Historic District (Name) <br />n ^ ,� 1 . <br />1.. e y � O�1 V 0W iP <br />❑ National Landmark <br />❑ National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled <br />❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) /� <br />Address of Property for proposed work: West' o+r l-4� y ef+- s <br />_' p (Street Number— Street Name— City--Zip Code) <br />Name of Property Owner(s): S o 4A, e� c� P 2 4- S Phon Z 35— R 4 Q � #: ,5 <br />Address of Property Owner(s): Z- r U.��C.l � - l ► e-��� so VA , I °`.-- &-,, I f - �G ( <br />(Street Number— Street Name — City—Zip Code) <br />Name of Contractor(s): ��'L�Y,i S m� ` 0`t`►+10.r- -��X'^ V "l,a,t '�'(/�hone #: 2 g 3 �g 3 2 J� <br />Contract Company Name: S C r t u,5 b se.�-V Gcp— C4 ct b� iriz , o `1 �� k-5 f�U o4<WoL, <br />Address of Contract Company: Z( S S <br />(Street Number— Street Name — City —Zip Code) <br />Current Use of Building: [&- L <br />�(Single F ( — Multi F — Commer — Government — Industrial f — Vac —etc.) <br />Type of Building Construction: <br />(Wood Frame Brick— Stone — Steel — Concrete— Other) <br />Proposed Work: ❑ In -Kind ❑Landscape New a ❑ Replacement (not in -kin) Demolition <br />(more than one box may be checked) (U t — Ire.ctS �- �'�r`�"(e.{" �o l e�5 ( P( tv &5 <br />Deser'ption of roposed Work: , W e re ee i %/ e k C ,[/ �C o d` q aLV'd� e, F CA e kC�s <br />� � p �.�. _ Get.. ✓e wt� � � se4 � t z 6 �e5• See PGt. �5 . C3a.� -� G4 to sus p � <br />Owner /Contractor Fax #: a -mail: q ' <br />5 i o'�_� A� <br />(Staff will correspond with only one designee) `� <br />X and /or X"'" <br />Signature of Owner Signature of Contractor <br />