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Past Reviews: YES (D.&- ofL.&R .I , D . O .2o 4S ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: \ CA�,- kkp <br />Application <br />-FOR - <br />Certificate of Appropriateness <br />HISTORIC PRESERVATION COMUSSION <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 TIUS BOX « «« OFFICE USE ONL <br />n 2 Y <br />Date Received: 2. maw � to Application Number: LON �0 — U:5 2 <br />❑ Local Landmark Local Historic District (N..Oj ;; it <br />❑ National Landmark ❑ National Register District (Ivan) 1 <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) 1 ' t/UL.Q , / / <br />Address of Property for proposed work: `� � S E. l/�u �w� 1,1 �.wC1 = ^ ' `v `1 o <br />(Street Numfer— StreetNam Zip Code) <br />ii C�C7`jtrLw `A <br />T d me of Property Owner(s): RIO tIZA - � tti5 Co C « <br />�5 i � ( X,4, 5c,, V (a h H 1 1 1 hone #: 5 7 `{ - � 3 Z "3 5)j <br />p GG <br />dress of Property Owner(s): � Z� l- , <br />, Y jc �J �� y�oUJ - 7 <br />(StreetNumber— StreetName— City —Zip Code) <br />Name of Contractor(s): <br />Contract Company Name: <br />c <br />AA I j � 5 � v%C. � n- Phone #: 6 7 — D <br />- At V'-e rtV <br />Address of Contract Company: <br />Current Use of Building: <br />Type of Building Construction: <br />to 0 u ,4 ee- ,-TAJ ,q�5 =V <br />- (StreetNumber— StrebtWame -- City —Zip Code) <br />(Single Fami / M l ulti Family--Cq n —Government Industrial — Vacant —etc.) <br />C&b <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 />De ption of Proposed Work Oe- ,,j I.6 � t� � J tl r� x 9er 1 �a,,. c e - 6 � � cl � <br />Ix 61� .0 �Gt,k DOA- - A � -v , r, Ift i \TI `�Vi�n fi <br />t� InC�dhhF.! •Tl-� P.c.Sv ,.tL (� ro i1 I��z bnwr�� v� �.c tiev� �9 �j , In <br />- Ceanc�,� i7 �h Fc,�y <br />4-f 6\&/ el A�e�A ,Q R, i.��,,o .s c�„, � �i — ree�4- <br />00"er /Contractor Fax #: �- N - �do Z ^ 17-7-1 e -mail: Cal- t:. 5 5 � � � Z ��^ �n ti � � . Gb ✓n <br />s taff will correspond with only one designee) <br />X /`1i1� and /or X <br />