Laserfiche WebLink
Application <br />-FOR- <br />Certificate ofAppropriateness <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, 1N 46601 <br />http://www.stj osephcountyindiana.com/departments/SJCBP/index.httn <br />p: 574-235-9798 f: 574-235-9578 e: SBSJCBPC@co.st-josephJn.us <br />OFFICE USE ONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY <br />Date Received: .3 "94 .2 9/s Application Number: 1:12015 — 0.,7-03 <br />Past Reviews: ❑ YES (Date ojLast Review) <br />Staff Approval authorized by: <br />DNO <br />Title: <br />Historic Preservation Commission Review Date: o2_0/5 <br />4 ❑ Local LandmarkLocal Historic District (Name) (i <br />❑ National Landmark National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) <br />Address of Property for proposed work: 91 q Aq/'ect (f e, s`j y66! y <br />(Street Number— Street Name—City—Zip Code) <br />Name of Property Owner(s): Ce L <br />Phone#: j-Z,'R'--C,Q•--, <br />Address of Property Owner(s): ' d .,­ 1 4 1- /Ptd aJ / ) jz- cS ,i l q ej / -zo <br />(Street Number— Street Name—City—Zip Code) <br />Name of Contractor(s): Phone #: S7 Y-) 10 -13 L <br />Contract Company Name: ,r!'a7!_�? �'Ghi P&J t3 z <br />Address of Contract Company: APO �/`�•ti, �U Y_ SQ 4tS ee.,ft 47 <br />(Street Number— Street Name—City—Zip Code) <br />Current Use of Building: I3 tGe►.sYJ fG T <br />Single Family—Multi-Family—Commercial—Government—Industrial—Vacant—etc.) <br />Type of Building Construction: _W 120 d �/iez m is a h pl sr4e G G iq <br />(Wood Frame Brick—Stone—,Steel—Concrete—Other) <br />Proposed Work: ❑ In -Kind ❑ Landscape ❑ New dReplacement (not in-kind ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: <br />Owner/Contractor Fax #: <br />(Staff will correspond with only one designee) <br />X <br />Signature of Owner <br />S <br />e-mail: KM 110,1'n S,tYj of/' G •%�jryJ <br />and/or X I/ <br />Signature of Contractor M( C, t tj S K I <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />