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Application <br />- .FOR - <br />Certificate of Appropriateness <br />HISTORIC PRESERVATION COND4ISSION ri 7i' <br />I <br />of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd: Bend, IN 46601; <br />http://www.stjosephcoumtyindian,l,pom/departments/SJCB"P/index.htm <br />p: 574-235-9798 f. 574-235-9578 e: SBSJC1PC@co.st-josephJn.us <br />OFFICE USE 0NLY>>>>>>DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX<<<<<<0FffCE USE ONLY <br />Date Received: ALtt i, Do& Application Number: <br />Past YES q)� �01� ❑ NO <br />Staff Approval authorized by: <br />Title: <br />Historic Preservation Commission Review Date- UA uot <br />❑ Local Landmark Local Historic District (Name) <br />WQtl no Fikeef <br />❑ National Landmark-- ❑ National Register District (Name) <br />Certificate of Appropriateness: <br />El ❑Ta led <br />Denied b El Sent To Committee ❑ E] Approved and issued: <br />(Please Print) <br />Address of Property for proposed work- E kt\1 a\j ne! 'S+ S. 13N)+k"� If"ha <br />(Street Number— Street Name­�Cit <br />P—Zip. Code) <br />Name of Property Owner <br />(s) 14�- AAJIN) P]i one ,57 3 <br />Address of Property Owner(s): Y)P I PDFE Y\A <br />(Street Numger­ Street Name — City —Zip Code) <br />0 <br />kf d <br />- of Contiactodr(sji _. �'': PWne#:(S-74),5 —,VC77� <br />Nami CD <br />Contract Company Name: /I <br />e- <br />4-1 Address of Contract Company: <br />(Street Nummm Street Name 7-CAA—ZiPPO <br />de) <br />Current Use of Building: , S - <br />Fam <br />ily_Multi­ $)�—commercial—Govemment—Industrial—Vacant—etc.) <br />Type B uilding Con sifucilo 0 - DAY , <br />(Wood Fram <br />Proposed Work: ❑ In-Kind ';E] La ❑ New Kkeplac (not in-kind) ❑ Demolition <br />(more than one box may be checked <br />15; <br />Description of Proposed Work: +N-A _ae e-•r 6IT(ck I n+0 <br />Lo-v on <br />an (,,D <br />yn <br />Ow;ne)r/C c orrespo n d Fax 0: e-mail: '3 hC'L(/1 <br />orrespond with only one desig <br />X and/or X <br />R 4 <br />iantahirp of numpr Qianafmirp of rnnfraetnr <br />