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Application <br />- FOR - <br />Certi ICate of Appropriateness <br />`t `�=5::� <br />HISTORIC PRESERVATION COMMISSION��x 1865 of SOUTH BEND & ST. JOSEPH COUNTY ''y1 I *lac <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http://www. stj osephcountyindiana. com/departments/SJCB P/index.htm <br />p: 574-235-9798 f. 574-235-9578 e: SBSJCHPC@co.st-joseph.in.us <br />OFFICE USE ONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY <br />Date Received: 11 1381 a0 i U Application Number: <br />Past Reviews: ❑ YES (Date ajLast Review) <br />Staff Approval authorized by: <br />I <br />Historic Preservation Commission Review Date: <br />FO Local Landmark <br />❑ National Landmark <br />' Certificate of Appropriateness: <br />❑ DeniedElTabled <br />10/ IS1301b ❑ NO <br />Title: <br />❑ Local Historic District (Name) <br />❑ National Register District (Nance) <br />❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) , �l +� j L! <br />Address of Property for proposed work: S-11 Vr , C 1 � 7'r�`�- -90 v 1�PW96A L-201 l� 1-&60 <br />p (Street Number—Street Name((—City—Zip Code) <br />Name of Property Owner(s): �31A �.� KkWN .e, k C/ ,Ort iljS�'i h I (✓kar,( Phone 9:7773 � 3c) -o 8,93 <br />Address of Property Owner(s): 1,q_ 'F CV \�� n /e_ L4. O eA4 ' LEG6 6 <br />(Street Number treet Dame—City—Zip Code) <br />Name of Contractor(s): 1 +0 9Q � kSCA M(r UPM Phone #: 3 -- <br />Contractor Company Name: <br />Address of Contractor Company: <br />(Street Number— Street Name—Cit <br />y—Zip Code) r <br />Current Use of Building: M 1x�� 0�'L4 CO rnnneri6 /l,( "7o Cl) C i�[^ref��l f9G'C4tZ-f– <br />(Single Family—Multi-Family—Commercial—Government .fz pstrial—Vacant—etcy. <br />Type of Building Construction: f' iC_�-'_ )_�: +0-n l CJ KU 0 & a I � - Uucco <br />(Voda Frame—Bricy-Stone—Steel-7toncrete—Other) <br />Proposed Work: In -Kind ❑ Landscape ❑ New Replacement (not in-kind) ❑ Demolition <br />(more than one box m be checked) //�� (� '' aa <br />Description of Proposed Work: PQ -P' G.GI nc Q,, ( (-cop S o (-T'G�e [^ Wk A4, me U'_j <br />Coo <br />f)8 <br />Owner/Contractor F #: e-mail: MCn M �(>✓ P r e�(�cc eS (asP'►�l C <br />X e t and/or X <br />Signatu a of ner Signature of Contractor <br />