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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 ONLY>>>>>>DO NOT COMPLETE ANY ENTRIES CONT NED IN THIS BOX<<<<<<OFF ICE USE ONLY <br />Date Received: Application Number: Zolu 0 L4 <br />Past Reviews: DYES (Date of Last Review) 2 <br />- Staff Approval authorized by: <br />Title: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark I q pLocal �Historic District (Name) 'Trx\f, A <br />FI National Landmark FINational Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee <br />I EJ ❑ Approved and issued: <br />.......... . ....... I'd ........ ........ . .......... .. . ......... <br />(Please Print) <br />Address of Property for proposed work: S2('0 S. C51, Jose-'4xsf 'SOCA 13C."d 1,k) ' <br />(Street Number — Street Name—City--Zip Code) <br />Name of Property Owner(s):AAC Cew4tors Phone #: 9W -� 133 <br />Address of Property Owner(s): JYDz M1�1 _)'Ou 51- tlou4 i8evd_7A) 4 Y , 6613 <br />(StreviNumber— Street Name—City­—Zip Code) <br />Name of Contractor(s): __6&JAJee <br />Contract Company Name: <br />Address of Contract Company: ------ <br />(Street Number— Street Nam,,,_[_S V. /�S <br />.T. <br />Current Use of Building: 6.mw 14r) M(P <br />(Singi Family — Multi-Family—Conunercial—Govei i4nt—Industrial—Vacant--etc.) <br />Type of Building Construction: /,t j oa d r— ji me <br />(Wood Frame — Brick -- Stone — Steel— Concrete — Other) <br />Proposed Work: ❑ In-Kind ❑ Landscape Ig New ❑ Replacement (not in-kind) ElDemolition <br />(more than one box maybe checked) <br />Description of Proposed Work: 6'reef a Pewee sofroamh r, <br />44e X1.14Yo,* ate-.?_ <br />beAwA 4Ae houce— 4oe &-old ase 4,, oce A ecl Lectace /.1 "If <br />(a fj�IA //cMC qX 17'S Celkce- -J .4 - 6,L Fe.S ie c S <br />Owner/Contractor Fax #: V41 <br />e-mail: <br />(Sta will corres an w ith on one d esignee) <br />and/or <br />Signatur e of Owner `Signature of Contractor <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE S <br />