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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:// ww-vv. stjosephcountyindiana .conVdepartments /SJCB P /indexltm <br />p: 574- 235 -9798 f- 574- 235 -9578 e: SBSJCBPC@co.st-josephin.us <br />OFFICE USE ONLY » »»DO NOT COMPLETE ANY E <br />NTRTF. ('ONTAINEDINTHICBOX« « «OFFI <br />ii _S CE USE ONLY <br />Date Received: U 4 Application Number: 0 C, <br />Past Reviews: ❑ YES (Date of last Review) Deg' 13/ 301F ❑ NO <br />Staff Approval authorized by: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark <br />❑ National Landmark <br />Title: <br />Atli (4 1 5 no_ <br />rM Local Historic District (Name) a hapi (I P eu k <br />❑ National Register District (Name) v 4 <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) -tom `t �l <br />Address of Property for proposed work: L LAimoN R KAC_E i ��r7 13END b(D <br />(Street Number- Street Name - City-Zap Code) <br />Name of Property Owner(s): SA RA ANI) A w7m 1 U 13AJ v Y 0 Phone #: 5 30 7 1 <br />b r� <br />Address of Property Owner(s): 4V LA vUtitS) — T- - , R_Q , Sv U7 7 14 `SF wT 4-6 6 t in <br />(Street Number- Street Name - City-Tip Code) <br />Name of Contractor(s): Phone #: <br />Contract Company Name: <br />Address of Contract Company: <br />(Street Number— Street Name— City—Zap Code) <br />Current Use of Building: �5 1 W Ct 1.T, Fl1N/� 1 Z & 7 <br />(Single Family- Multi - Fam(ly- Commercial- Government - Industrial Vacant -etc.) <br />Type of Building Construction: I v CmD pr- Avg - <br />(Wood Frame - Brick - Stone- Steel - Concrete - Other) <br />Proposed Work: 0In -Kind ❑ Landscape ❑ New Replacement (not in -kind) ❑ Demolition <br />(more than one box may be checked) <br />M <br />Description of Proposed Work: IZF�T 1� i 1d7�J or TNG FgfpvT I -1A-L1 o,;t f' /a <br />— T#15 AleLuDR -S A n4 AevD 1n1.5'1 A/ &c,/ 51DIrr <br />.d c v l> — Tx i e" - 'TL> MA7 q Tit1s O P-161 AIA L CSC /Qz�� plla ra ,4'T,Q �ua'��. M A w t9 w tnl 'A aw$ <br />`,vtt_t. - BE kFj>AtPGn . 5Ev51v MAQv WINDC?v5 WILL 3F wj? - biviD,5D �7 <br />� T° mliTcrt 5r v t=7v Z"4 pig w t rvX I I Ar W )L L_ 135 <br />Owner /Contractor Fax #: e -mail: baj u y ® P _ m a <br />(Staff will correspond with only one designee) <br />X�� A , and /or X <br />Signature of Owner 4c:::r Signature of Contractor <br />