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071E�� <br />-FOR- <br />Certificate cfApprapriatenesas <br />HISTORIC PRESERVATION COMNUSSION °,��. � c4� <br />of SOUTH BEND & ST. JOSEPH COUNTY syr. Fla <br />125 S. Lafayette Blvd., South Bend, 1N 46601 <br />http://www.Stiosephcountyindiana.com/departments/SJCHP/index.htin <br />p: 574-235-9795 f: 574-235-9578 e: SBSJCEPC@cost-joscph,in.us <br />joscph.in.us <br />.44w.iW..noY,W,wwm.r.liiWdeY..r�...... ............ <br />w.wm. nwW.uJiplW W1u11.4Y.Y111 iY LLiw.e..WYirWbuaw WdiwWiwu.-.�� <br />OFFICE USE_ONLY»»»cDO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY <br />Date Received: 1� �, � .J Application Number: �' — '1005 <br />Past Reviews: ❑YES (Date afZast Review) ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: Ncl ik / <br />❑ Local Landmark L J Local Historic District (Nmne)i iG <br />111LAA <br />1i ; <br />❑ National Landmark []/National Register District (Name) <br />- 6 <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee F1Approvedand issued: <br />-fir_- .__ ... . i •i. i i.Y-ii.idi�1.W I.�.w1w..Win W ... � w ... .. __....,.-"'WY` - - ., _- ` <br />(Please Print) <br />Address of Property for proposed work: 86- Pr54 LAnil) AVE. 500rk4 4 LAO ILP <br />(Street Number— Street Name—City—Zip Code) <br />=Name of Property Owner(s): PA*104 � . biAaA 1 D Plot -.S Phone #: ,S-44- 2AZ- -443 <br />Address of Property Owner(s): +a1.77 ALAND AVS- 5,00r)I ?3EV3D 4w.1 L. <br />(Street Number— 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—City Zip Code) <br />Current Use of Building: 5fr1U,UC, FAmii-4 <br />(Single Family --=Multi Fami(y--Commercial--Government—Industrial—Vacant—etc.) <br />Type of Building Construction: W000 FOM " <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: <br />'Ou2 <br />C-.ARh6C AA.5-FMLO� <br />1PATO DJL "1'G 907rrAb- <br />?ri=.. rT <br />Nom l��i�S 7`ta Pi -0 <br />o of 4 k T)R)Vet-'Aq - LOT <br />-rrM i7- <br />&EVagE rr FALLS, ooTo <br />rNerp. CABS. <br />Owner/Contractor Fax #: e-mail: <br />(Staff will correspond with only one designee) <br />X and/or X <br />Signatu caner Signature of Contractor <br />