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r <br />:1/ <br />Application <br />-FOR- <br />Certi Kate 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.ht n <br />p: 574- 235 -9798 f. 574- 235 -9578 e: SBSJCBPC@co.st-josephJn.us <br />" 1 OFFICE USE ONLY» » »DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX «« «OFFICE USE ONLY <br />Date Received: , Wlb Application N� " umber: � 1 � — 073qA <br />Past Reviews: RI YES (Date of Last Review) l Ioj l U ❑ NO <br />Staff Approval authorized by: <br />Title: <br />Historic Preservation Commission Review Date: L( F51 l q <br />❑ Local Landmark ® n Local Historic District (Name) 1 hQ `Ill pok <br />❑ National Landmark ® National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) ��11 J , q� <br />Address of Property for proposed work: jb L( �[/ /vQ ua4, ` �� <br />(Street Number— Street Name -- City—Zip Code) <br />Name of Property Owner(s): 60".'ot �J � �J Phone #: <br />Address of Property Owner(s): 2) Lc <br />(Street Number— Street Name -- City --Zip Code) <br />Name of Contractor(s): 01 Phone #: <br />I �� 1 L <br />Contract Company Name: � cc�.y h,< �/e <br />Address of Contract Company: ( &__X, <:4 6 a 6 5 ,6,r^ <br />// (Street / Number — Street Name —City -Zip Code) <br />Current Use of Building: �2? /,' 417) l <br />(Single amily— Multi- Famil_Commercial— Government — Industrial — Vacant —etc) <br />Type of Building Construction: <br />(Wood Frame Brick -- Stone -- Steel— Concrete— Other) <br />Proposed Work: ❑ In -Kind ❑ Landscape ❑ New Replacement (not in -kind L Demolition <br />(more than one box may be checked /1 <br />Description of / P ) ropos d Work: /%0-1.716 V, r� lr l ems / h n SL ± E' ��U' �t ol1 �cu I <br />i1 /_..ca/l/.� �f.ei4_P .�CJa � � S Ca ., G� m n kv 'S�c.� � rLO�J �[r�C.P /(' !l�✓1 Z -¢�"tC <br />n V✓�v -, � d � r �� �,P Wiz/ � � 0 <br />Owner /Contractor Fax #: e-mail: K e( 4" - v t t <br />(Staff will correspond with only one designee) <br />X and /or X <br />Signature of Owner Signature of Contractor , <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />