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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/SJCBP/index.htm <br />p: 574-235-9798 f. 574-235-9578 e: SBSJCBPC@co.st-josephJn.us <br />OFFICE USE ONLYS»»>DO NOT COMPLETE ANY ENTRIES CONTAINED IN TMS BOX«««OFFICE USE ONLY <br />Date Received: 1�15 O cIt <br />Past Reviews: ErYES (nate ofLast eevkw) <br />Staff Approval authorized by: <br />Historic Preservation Commission Review Date: <br />i <br />F1 Local Landmark <br />❑ National Landmark <br />i Certificate of Appropriateness: <br />❑ Denied ❑ Tabled <br />Application Number: OJ lJ- <br />.�_ ?ItT. l-rf <br />/ 9 60d'9 7-DiS <br />Local Historic District (Name) <br />❑ National Register District(rvame) <br />Iwo -5 Cr <br />❑ NO <br />Title: <br />I <br />❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) c <br />Address of Property for proposed work: pp l 7%�' U)C1.yh6 F. k <br />(Street Number- Street Name -City -Zip Code) <br />Name of PropertyOwner(s): : 6` 6'1d al�-K f Phone#: 577`d3:3-ig5& ■ <br />`i7o N� xic3� <br />Address of Property Owner(s): 40JYYLfL uu <br />(Street Number- Street Name -City -Zip Code) <br />Name of Contractor(s): �t�] l� l l:�v► �� f-t� l/1,>aG�7�-/Ci ,C? Ct Ce,f�1CPhone #:'� �L J �f <br />Contract Company Name: OS i <br />Address of Contract Company: '71 &11 L►1 A -j, _DJ <br />(Street Number- Street Name -City -Zip Code) <br />Current Use of Building: A1L/YtGl�-t/l/YI'll�/ <br />(SiWgle Family-Multi-Fam,,y-Commercial-Government-Industrial-Vacant-etc.) <br />Type of Building Construction: W6061 )C:R1j_M Z_= �l 1 <br />(Wood Frame Brick-Stone-,Steel!Concrete-Other) <br />Proposed Work: ® In -Kind ❑ Landscape ❑ New ® Replacement (not in-kind) ❑ Demolitionj <br />(more than one box may be checked) <br />Description <br />iof Proposed Work:= .-snuz dmr uf�j !o�C kc>tCx�1ty(D/y®wih,Q- 2L <br />Sn nA uninq 't&dr�r !e kamp to tem c'& IaA QYi <br />811"! <br />Owner/Contractor Fax #: N171- e-mail: <br />(Staff will correspond with only one designee) J <br />X j Jr ��} - a -til¢ 1S and/or X %fir / )1 i Peepz-t �ilu S°fM 4JA <br />Signature iff Owner Signature of Contracto <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE- <br />