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Application <br />- FOR - o s� <br />U <br />Certificate ofAppropriateness o <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http://www. stj o sephcountyindiana.com/departments/SJCB P/index.htm <br />p: 574-235-9798 f: 574-235-9578 e: SBSJCHPC@co.st-joseph.in.us <br />OFFICE USE ONLYy»»>DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY <br />- Date Received: !� ate 1S Application Number: <br />Past Reviews: YES (Date of Last Review) i ` / 12 " )T i ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date:((t <br />❑ Local Landmark 12/ Local Historic District (Name) <br />❑ National Landmark ❑ National Register District (Name) <br />Certificate of Appropriateness: 3 <br />❑ Denied ❑ TabledElSent To Committee ❑ Approved and issued: <br />(Please Print) <br />Address of Property for proposed work: GL,V1G Com- 4- 'SAD V-�-� <br />,11 (/Street M ber— Street Name—City—Zip Code) <br />Name of Property Owner(s): p1r+� it ne_+ne.f / `rorrn Sw1 z eJL. Phone #: 5-4-94)_1-41'Z;5 <br />Address of Property Owner(s): (10-5- F_ ' LJ 6-N4 r P. '�4- . 1p" ' A Lt to (o l <br />(Street Number— Street Name—City—Zip Code) <br />Name of Contractor(s): SWI -Lig lL.. EiJ-�t��v iscS t (r� r Phone #: <br />Contract Company Name: I <br />Address of Contract Company: SS%lv�` G�'�'r�^ + <br />(Street Number— 1reet Name—City--Zip Code) <br />Current Use of Building: <br />(Single Fly—Multi-Family—Cor}rmercial—Government Industrial—Vacant—etc.) <br />Type of Building Construction: <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: Land t.ce,Dc. [�, ,;. S V_Cw,oYa-1 t d►ri VGwa-I 4v_4-ev Rayi I <br />ee- ;^ <A I! &ora <br />Owner/Contractor Fax#: 5"14-Z33-L.'i33 a-mail:e t -art,_ Gdwt <br />7%kvv <br />only one desi ee) <br />and/or X <br />Signature of Owner Signat4s-of 16ont ctor <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />