Laserfiche WebLink
Applicati ®n <br />-FOR- <br />Certificate ofAppropriateness m <br />i <br />HISTORIC PRESERVATION COMMISSION ' <br />of SOUTH BEND & ST. JOSEPH COUNTY m�yr ,1� °ten <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http:// www. stjosephcountyindiana .com/departinents /SJCHP /index.htm <br />p: 574- 235 -9798 E 574- 235 -9578 e: SBSJCB:PC@co.st-josephJn.us <br />„..........,..,,..., .,. . .... ..........., ..,....... <br />OFFICES USE O { NLY» » »DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX «« «OFFICE USE ONLY <br />-Date Received: ^ <br />, f 11Y 11 �Q Application Number: D l L — N Q 1 <br />Past Reviews: i YES (Date of Last Review)` J V (�� ❑ NO <br />Staff Approval authorized by: F/� Title: <br />Historic Preservation Commission Review Date: f py-i !/ <br />❑ Local Landmark Local Historic District (vamp CAV 1 fA { C, (y <br />❑ National Landmark National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled El Sent To Committee F] Approved and issued: <br />(Please Print) <br />Address of Property for proposed work: ) �2k , J�� i�•�s� {X6 16 <br />(Street tuber — Street Name — City —Zip Code) <br />dame of Property Owner(s): (2 0 Ll Phone #: <br />Address of Property Owner(s): O 1 7>4 W U /AI 04 (Street�lVumber— StreetName— City —Zip Code) <br />Name of Contractor(s): p 1. or: Phone #: <br />Contract Company Name: <br />Address of Contract Company: <br />(Street Number— Street Name — City —Zip Code) <br />Current Use of Building: (lAlrt l! <br />`I (Single Family —Multi famil)— Commercial— Government — Industrial — Vacant —etc.) <br />Type of Building Construction: t,�p� %:,®.47r, � <br />(Wood Frame — Brick— Stone — Steel— Concrete— Other) <br />Proposed Work: ❑ In -Kind ❑ Landscape aNew Replacement (not in -kind) ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: <br />mo6wner /Contractor Fax #: e-mail: 0 o ho A <br />(Staff will correspond with only ne designee) <br />X and/or X <br />Signature of Owner Signature of Contractor <br />