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Application GQ�f4SdaN�9s <br />�A ani r o. <br />- FOR <br />Certificate ofAppropriateness m <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND & ST. JOSEPH COUNTY syr *tia <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http://www.stjosephcountyindiana. com/departments/SJCHP/index.htm <br />p: 574-235-9798 f: 574-235-9578 e: SBSJCHPC@co.st-joseph.in.us <br />OFFICE USE ONLY»>>»DO NOT COMPLETE ANY ENTRIES CONTALNFD IN THIS BOR«««OFf7CE USE ONLY <br />I ' <br />Date Received: 7 l'i'tAAt,420t5 Application Number: r20fS — OSO-1:_13 <br />ti <br />Past Reviews: FRIVES (Dau.fL.R.*.) ❑ NO <br />Staff Approval authorized by. Title: <br />Historic Preservation Commission Review Date: i i? M A)" ao t,S <br />❑ Local Landmark Local Historic District (Nano) AYt.e� i2 `S f /GL 17 <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: <br />(Street Number— Street Name---City--Zip Code) <br />Name of Property Owners : 3 ~ c <br />P ' •7 () .L,�.cr.. e�....,..b ..�i�.r��...,,,. i...3 �{�c.Gi'(.�, Phone #: �;M"'�'�F! <br />Address of Property Owner(s): S- '�S l S '(L, U E - pL. So c..lt _ -ke. r( it, <br />(Street Number— Street Name--City—Zip Code) tr <br />r <br />Name of Contractor(s):Phone #: <br />Contract Company Name: <br />Address of Contract Company: <br />(Street Number— Street Name---City—Zip Code) <br />Current Use of Building: 'C'' r�_ —I <br />(Single Family—Multi-F'a iiiy--Commercial—Government—Industrial—vacant---etc.) <br />Type of Building Construction: _�__ +1,4_ <br />(Wood Frame—Brick--Stone--Steel---Concrete—Ot)ier) <br />Proposed Work: ❑ In -Kind ❑ Landscape LRU41 New ❑ Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: , r�s1 <br />rt- - ,--t, k ---A ( x -• q • . . 5' . . 4. J_ <br />1 i`l r!►'-�`•� U,I. jY. inr l� t�.7-�•r 4- <br />s� '�:, ..1Gf C•i.. ,.�.4. W 7 p . �•. "t f ro <br />�Y e -l•. G to � d �.�, v taK sel L tt .`^�" V T� p �- <br />Owner/Contrac"tor Fax #: e-mail: <br />(Staff will correspond with only one designee) <br />X . ` • t and/or X <br />Signature of (3 eKJ Signature of Contractor <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />