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_: <br />�SpUTk[ Application +`000ISSIONfRs <br />-FOR- <br />Certificate of Appropriateness �6 <br />G � <br />HISTORIC PRESERVATION COMMISSION 0 <br />x 1865 K of SOUTH BEND & ST. JOSEPH COUNTY syr *Na <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: SBSJCHPC@co.st-joseph.in.us <br />OFFICEUSEONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN/THIS BOX< -OFFICE USE ONLY <br />Date Received: I't / t I Application Number: J— 0 02— <br />Past <br />2— <br />Past Reviews: ❑ YES (Date of Last Review) ❑ NO <br />Staff Approval authorized by: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark <br />❑ National Landmark <br />Certificate of Appropriateness: <br />❑ Denied <br />Title: <br />MAI V) <br />❑ Local Historic District (Name) Ci r <br />t <br />❑ National Register District (Name) <br />❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) <br />Address of Property for proposed work: <br />Name of Property Owner(s): .5 A <br />S�� kalve, Gcvde4_� I+ %e t --W TC41- <br />(Street <br />Number— Street Name—City—Zip Chide) <br />01st • Phone #: <br />Address of Property Owner(s): <br />J / (Street Kuumber— Street Name—City—Zip Code) / <br />Name of Contractor(s): {� t% r-1 '-0 r'"J Phone #: 1 D -197f <br />Contract Company Name:�5k �yz�� 1 R� s e5 <br />Address of Contract Company: ` rW 1 yG�l 7 <br />(Street Numbers— Street Name—City—Zip Code) <br />Current Use of Building: & Cw t1 eqA <br />(Single �Family—Mztlti-Family— .) <br />Commercial—Government—Industrial—Vacant—etc <br />^ J <br />Type of Building Construction: 1 � / A <br />(Wood Frame—Brick—Stone—Steel—Concrete—Other) <br />MIT <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: <br />Owner/Contractor Fax #: e-mail: <br />(Staff will correspond with only one designee) <br />X and/or X <br />Signature of Owner Si at <br />e 'C �ctof <br />—APPLICATION REQUIREMENTS ARE L SPED ON REVERSE SIDE— <br />