Laserfiche WebLink
Application <br />- FOR - <br />Certi ficate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />Mailing Address: County -City Building, South Bend, Indiana 46601 <br />Phone: 574-235 -9798 • Fax: 574 - 235 -9578 • Email: SBSjCHPC@co.st -joseph.in.us <br />Website: wwwsgosephcountyindiana .com /sjchp /index.html <br />A Certified Local Government <br />OFFICE USE ONLY—­­ DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX » »» OFFICE USE ONLY <br />Date Received 3ah, 11 wiu Application Number 2 0 1 j - 071 1 A <br />Past Reviews JZ] YES (Date of Last Review q I d2J 1 420 ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: <br />❑ Local Landmark Local Historic District (Name) __&DiA atk. <br />National Landmark National Register District (Name) <br />Certificate of Appropriateness: <br />R Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and Issued <br />DATE <br />ddress of Property for proposed work: n 7 C r2s Ar_� . <br />Name of Property Owner(s): (Please Print) <br />_ <br />J An' 2S <br />( Street Number and Street Na e <br />'t t {c'. b G�'� LC'( V'41 <br />Address of Property Owner(s): 2 � 7 - <br />W6LlLP_LwL <br />Are . Sz), <br />Air -J Il 1 �6f t �Z - <br />Contractors) Name: IJ el, CSI v' <br />Contract Company Name: L 6 N v✓ e s <br />A <br />Contractor Address: E <br />V _ <br />City: A A,t s fn a vv ( Phone: <br />Current Use of Building: J; �;, 1 r? � r,,1 l W <br />0 (Single Family — Afulti- Family — Commercial —Government —Industrial — Vacant —etc.) <br />Type of Building Construction: V v v"r d 41" - 1/N e <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: ❑ In -kind [] Landscape [Z/New [ (not in -kind) [:] Demolition <br />(more than one box may be checked) r <br />Description of Proposed Work: n _-A r 'L � <br />tor: Fax: e-mail V ecca . ri.ilc- Aora!v�a <br />on only o ignee) U J <br />and /or <br />Signature of Ow er Signature of Contractor <br />— APPLI TION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />