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Application <br />-FOR- <br />Certificate 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: SBSJCflPC@co.st-josephJn.us <br />OFFICE USE ONLE'S» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY <br />Date Received: '? G�.J Application Number: r:2045- — O ;%d �2— <br />J U <br />Past Reviews: YES (Date of Last Review) ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark <br />❑ National Landmark <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled <br />"20 .2o /S <br />® Local Historic District (Name) W G �-fyc ei <br />❑ National Register District (Name) <br />❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) <br />Address of Property for proposed work: ; �, el p6 �<�&e l J01 4/#7, FQ(!Th Ae4d, lIV46��`� <br />(Street Number— Street Name—City--Zip Code) <br />—ame of Property Owner(s): h Anna Anki-, Phone #: $%�/� a j1-. 797 <br />Address of Property Owner(s): 123e E W-Nne Are4 S0114 cr,9ah 617d, // r -f-W,5 <br />6k/� (Street Number— Street Name—City—Zip Code) <br />Name of Contractor(s): . ' a 1.6 Phone #: 57� 319 <br />Contract Company Name: /'��, DY,� ( 'j'j,(7y1/i's�7L�1 t /J�>u}'jL� /` .1,jj j7Lna0jfe1 <br />Address of Contract Company: ��� %�/GZcSiGI � �i�i c�l��/ / tl� } fG�. //V <br />(Street Number— Street Name—City—Zip Code) <br />Current Use of Building: c )!{�%%' fA_lrilk <br />(Sjgle Family—Mtt Family—Commercial—Government—Indiutrial—Vacant—etc.) <br />Type of Building Construction: Weild kalwe-- <br />(JVood 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 />�j <br />Description of Proposed Work: <br />V <br />—Owner/Contractor Fax #: �U4 8M4 a -mail: J_M& a e /{'t'i/f'i/11(;`C <br />(Staff will correspond with only one designee) <br />X and/or X <br />Signature of Owner Signattuure of Contr ca for <br />