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Fkgl if' <br />0- <br />�3 MWI 11 , Ul <br />-FOR- <br />Certificate <br />FOR- <br />Cterti cate 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: SB.SJCH.PC@co.st-joseph.in.us <br />OFFICE USE ONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN TIIIS BOX ---OFFICE USE ONLY <br />Date Received: Application Naamber:, <br />Past Reviews:© YES (Date of Last Review) �J` 1 /0 � N® <br />Staff Approval authorized by: <br />Historic Preservation Commission Review Date: <br />® Local Landmark <br />® National Landmark <br />Certificate of Appropriateness: <br />11 Denied ® Tabled <br />Title: <br />� 0/ of <br />Local Historic District (Name) <br />® National Register District (Name) ,v � (,c— <br />Sent To Committee ® Approved and issued: <br />(Please Print) <br />Address of Property for proposed work: 624 Park Ave. South Bend 46617 <br />(Street Number Street Name—City--Zip Code) <br />Name of Property Owner(s): Jason Springs Phone #: <br />Address of Property Owner(s): 824 Park Ave. South Bend, 46617 <br />(Street Number— Street Name—City—Zip Code) <br />Name of Contractor(s): <br />Contract Company Name: <br />HomeWorks Construction <br />Address of Contract Company: 1511 Pulaski St. South Bend, 46613 <br />Current Use of Building: Single family <br />Phone #: <br />(Street Number— Street Name—City—Zip Code) <br />617-233-2765 <br />(Single Family Multi-Family—Commercial—Government—Indiistrial—Vacant—etc.) <br />Type of Building Construction: Wood frame <br />(Wood Frame—Brick—Stone—Steel—Concrete—Other) <br />Proposed Work: ® Ire -Kind ® Landscape ® New 4FReplacement (not in-kind) ® Demolition <br />(more than one box may be checked) <br />Description ®f Proposed Work: Remove existing siding and install new L P Sr r XAt' <br />Owner/Contractor Fax #: 574-607-9414 e-mail: Jgava@g omeworks.co <br />(Staff will correspond with only one designee) I^ <br />X and/or X <br />Signature of Owner Signature of or <br />