Laserfiche WebLink
Application <br />-FOR- <br />Certificate <br />FOR- <br />Certi icate of Appropriateness <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/SJCB P/index.htm <br />p: 574-235-9798 f 574-235-9578 e: SBSJCHPC@co.st-josephJn.us <br />OFFICE USE OiNL I{y»»>DO NOT COMPLETE ANY ENTRIES CONTAINEDINTHIS BOX«««OOFFICE USE ONLY <br />Date Received: I J Application'Number: <br />Past Reviews: YES (Date ofbwReview) Jam, 2n 1,4 ❑ NO <br />Staff Approval authorized by: t l i Title: <br />Historic Preservation Commission Review Date: 1 t I l <br />❑ Local Landmark❑Local Historic District (Name) Cihoti 1 n V C - <br />❑ National Landmark National Register District (Name) l r \ O F l n PCUK <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) 22 / L-�' <br />Address of Property for proposed work: J07 �hm v� l GYIAG� <br />(Street Number— <br />Street Name—City—Zip Code) <br />Name of Property Owner(s):Phone #: <br />Address of PropertyOwner(s): <br />(Street Number— Street Name—City—Zip Code) <br />Name of Contractor(s): l��% �l� l✓l� Phone #: 630 <br />i <br />Contract Company Name: if-�j C�? %'; Piz. L- —C <br />Address of Contract Company: 2,0 <br />(Street Number— Street Name—City—Zip Code) <br />Current Use of Building: /( �_,_ ?��A <br />(Sin/gle�J` ►�F�a-mi4—Multi!Family—Commercial—Government I .) <br />ndustrial—Vacant—etc <br />Type of Building Construction: vV �l ul,a,axL <br />(Wood Frame—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: IZr,A j a. C*. 41/ ti" J a Lv5 6 1f_ <br />�ra-ms.,r'% . ,�o�blc-I.�..v� ,,,,.a �.se�r-/k'e-•r �e,�.,.� ozr f�.��,ke_ <br />�O l� to. 0. i"��� Strfn� l�S 1.✓/�L7 1�.�_��-an �Lv� Q is In i +a a('vta� c�rw�C v>>JOry�Lf <br />Owner/Contractor Fax #: <br />(Staff will correspond with only one designee) <br />X <br />Signature of Owner <br />e-mail: <br />and/or X--' <br />Signatu?--O/-C- <br />actor <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />