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Application <br />-FOR- <br />Certificate o., ppropriateness <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />hq://www.st osephcountyindiana.com/departments/SJCHP/index.htm <br />p: 574-235-9798 f: 574-235-9578 e: SBSJCBPC@co.st-joseph.in.us <br />OFFICE USE ONLY -->>DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY <br />Date Received: %Z&q- -1- O 15 Application Number: O 45 '40, <br />v � <br />Past Reviews: Ego;YES (Date of Last Review) % 7 -Y�a d 8 ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: /2Xd,, c;70 ,r <br />❑ Local Landmark ®Local Historic District (Name) cka-la� <br />P�� <br />❑ National Landmark ® National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) r + <br />dress of Property for proposed work: 93-o f � Y'� o � c- , -G -r aA 3 k/ A ( (G <br />(Street Number- Street Ame-City-Zip Code) <br />Name of Property Owner(s): (L -L 4 < <- i- 6't -F Phone #• -+ ' 31 7 - '(-I -P <br />Address of Property Owner(s): g 3D (9 AFDC AV, f � i3�� , t /4 <br />(Street Rumber- Street Name -City-Zip Code) <br />Name of Contractor(s): Phone #• <br />Contract Company Name: <br />Address of Contract Company: <br />(Street Number- Street Name -Cit <br />y -Zip Code) <br />Current Use of Building: S . rr C, L- F- FA ^ t Ly <br />(Single Family -Multi Family -Commercial -Government -Industrial -Vacant -etc.) <br />Type of Building Construction: L'j-no v FO-Ar1C <br />(Wood Frame -Brick -Stone -Steel -Concrete -Other) <br />Proposed Work: ❑ In -Kind ❑ LandscapeNew ❑ Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: A- Cv d.+r f, �- <br />t�-G• � .M-' '�� v�-� -- J:�„` a�iz.,;r,�'e� ci-a u-�-..mss--�('S <br />Owner/Contractor Fax #: e-mail: <br />(Staff will correspond with only one designee) <br />X ' �° � i and/or X - ^ . <br />