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0 <br />Application <br />-FOR- <br />Certificate of Appropriateness <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http://www.stjosephcountyindiana.com/departments/SJCB P/index.htm <br />p: 574-235-9798 f 574-235-9578 e: SBSJCBPC@co.st-josephJn.us <br />OFFICE USE ONLYY> »»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY <br />Date Received: IN \ <br />\01/ 1 J Application Number: 101 _5 — I I ()Q_ <br />Past Reviews: [g/YES (Date oJLast Review) 12 + 5 "ILA `'1 ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: 1 I 1 t t' • ` I D `n <br />❑ Local Landmark Local Historic District (Name) �1 1 I V� � lv <br />❑ National Landmark 5/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: ?0 (a Le I&,, d A vG • S-23 IN V (P 6 )1, <br />(Street Number— Street Name—City—Zip Code) <br />Name of Property Owner(s): T>Ow ns <br />Phone#: 61 4- Z9k-0559 <br />Address of Property Owner(s): For c 5 Ir Av a . So v+ h 3c.r.d . / A/ ails b 1 la <br />(Street Number— Street Name—City=Zip Code) <br />Name of Contractor(s): S u h u e // Ft n c C �t7 Q b e Phone #• 5? y- IQ 00 <br />Contract Company Name: S vA u. a // F t n e I -- <br />Address of Contract Company: %2 Q 3 -4V A t44-5 R o c et- S 8 / r/ L/& 4 2 S, <br />(Street Number— Street Name—City—Zip Code) <br />Current Use of Building: V1 r+S 1 c F& en . 14 <br />(Single Family—Mzilti-Family—Commercial—Government—Industrial—Vacant--etc.) <br />Type of Building Construction: W o o cl ff a m <br />(Wood Frame—Brick—Stone—Steel—Concrete—Other) <br />Proposed Work: ❑ In-KindLandscape 11NewrVI Replacement (not in-kind) ElDemolition <br />(more than one box may be checked) <br />Description of Proposed Work: I n S g a I 1 P r t v o c.f f am t o A (o n ,j S o„ i Aer e% b o a.. d cr <br />Pro 0e-& -y v P '1-0 Q✓e a Q troSS -r-orn owe )34Seepnen* door - <br />I'll U 5 <br />oorI'llu5 no* o6srctr,nq 41,a doL_; of 11,,e r,.irk6or,,r1e+ <br />A o tris -l-D 4--A a so .j 44,. J <br />Owner/Contractor Fax #: 5? y - oZ? I - $ I S (e <br />(Staff will correspond with only one designee) <br />X <br />Signatire of Owner <br />e-mail: Lce/I ncG e- Gorncas/, n -G71- <br />and/or X n'e� 1.40of2 <br />Signature of Contractor <br />