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0013T11d� Application `Qµµ1SStOryf9� <br />� X��• - c� Certificate of Appropriateness <br />y — az HISTORIC PRESERVATION C01lMISS1ON <br />1865 of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />littp:/hcw\\,.stjoseplicountyiiidiana.com/departments/SJCHP/iiidex.litni <br />p: 574-235-9795 f. 574-235-9578 e: SBSJCIIPC @co.st joseph.inms <br />OFFICE LSE• O.\'Ll>>»»>DO \nT CO\11'LF:I F. A\1• EN TRIES CO\TAI\ED 1\ THIS BOX --OFFICE, USEOATY - <br />Date Received: i�Jh11' lX Application Number: <br />Past Reiims: ❑ YES (DeteoflasiRevi h-) ❑ NO <br />= Staff Approval authorized by: <br />Historic Preservation Commission Re%icii Date. <br />Title: <br />❑ Local Landmark Local historic District <br />❑ National Landmark 54ational Register District (.v,oae) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) �� <br />Address of Property for proposed work: GCfl LjCAQnd Sd LA``__ \ r, [� Ad '� , �. i <br />�,��,,,,`` (.Slreel AIwnber— Street A�(ftme—Ct11=2111 Cod) <br />� itil�ih�y <br />Name of Property Owner(s): �wef—A Reighba(,1C031 T1 L Phone #: <br />Address of Property Owner(s): 1OA, 1?o(\ PC4e �A� l &t� . its L.,1 G l91 �p <br />% : (Streel Nwnber--- Street \•ante—Cil}°-7rp Code)) <br />Name of Contractor(s): �'j16]il {at•t �, p,t.)d m1Akt21C Phone #: , /'�� •'7�Z' t`tj�/ i-' <br />Contract Company Namc:E& 2E► 6')/`{ C(�ifJ� j b J �l 1 <br />Address of Contract Company: 4- b Z \� • W —M I �� <br />` f \ (St\reet .\'tunber—Street Xame—Cit—zip C ocfe) <br />Current Use of Building: VAC '1' iO�e� & ld \char) QS pts LS.�• ��� <br />(Shkg1 e_1 atlnl,I—.lht/ti-Fatiiilj=('onintercial—Goreiittlieitt---lildtlstrial—f avant—etc.) <br />Type of Building Construction: W(co -� Gt'�e <br />(11-ood Fi,airie—Brick—Stone—Steel—Concrete---Other) <br />Proposed Work: In -Wind Landscape ❑ New <br />(more <br />(not in-kind) Demolition <br />(snore than one box nim• be checked) ��jj� ,\,1 <br />Description of Proposed Work: Wase Ste (-Q-wp hev <br />Owner/Contra Fa\ #: 'RCX1P e-mail: �-z.e ��e�Q (��ltPl��H+ �S • 6r�j <br />(Staff ivilf ).resp id ivith On1v one designee) WreofonEr <br />a andlor 1Signatur ivner Sign <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />