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t <br />Application <br />-FOR- <br />Certificate of Appropriateness T <br />t �'7 HISTORIC PRESERVATION COMMISSION 0 <br />1865 ` of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http://www.stjosephcountyindiana.c om/departments/SJCHP/index.htm <br />p: 574-235-9798 f: 574-235-9578 e: SBSJCHPC@co.st-jose <br />ph.irll.us <br />OFFICE USE ONjLY» r»>»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFti;E USE ONLY - <br />Date Received: I 1 aO i LP Application Number: A� — 0921 <br />Past Reviews-. fRI YES (Dare of Last Rndew) <br />Staff Approval authorized by: <br />10/07/300q ❑ NO <br />Title: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark Local Historic District (Name) l /� �^ <br />api fi -pQ (c . <br />❑ National Landmark ® National Register District(Naa,e) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee❑ Approved and issued: <br />(Please Print)`.,. ti t <br />Address of Property for proposed work: _838 ` A K K AYE SQ{vV 6 146 <br />(Street Number— Street Name—City—Zip co <br />Name of Property Owner(s): Ma 1Z IM 4--KRIMN / <br />%KDER hone 'p#: b� <br />Address of�Property Owner(s):.958 PhRK 46 sri j,J�rb#�ir�,iS r�� j1�(yj�7 �, �� Q& 7V Pmw <br />�s` t A�L[JQeet4�Numr'Sry�Ve Irl •SmF� li�/ +`JjA 77 <br />Z 'W <br />Name of Contractor(s): ---,W t2 y M �_t+��- Phone #: <br />Contract Company Name: S*4V A -S #" 6V V „ <br />Address of Contract Company: 16q-bl n6 RD, M 16144whm w ,46 5-�Z6 <br />J ,»/� (Street Ni— Street Name—City'—Zip Cod <br />Y e) <br />Current Use of Building: ICON% Sj/vt�E WE hrt1a(5. #r M ; fir k p l/,, I 1,9,W <br />(Sing(e$ami� a {;�atnily—Camtn�� oa ���1"s tci�Tftl �<�t✓/Y��"' <br />Type of Building Construction: S!!�/ll''YYOOvS1�N fC�GLQ7� W(�'ry�' {�f©j �t•- " i�Bu�'f` <br />(JVood Frame—Brick Stone—Sieet--Concrete=Other) <br />Proposed Work: ❑ In -Kind ❑ Landscape ❑ New ❑ Replacement (not in-kind) WiDiemolition <br />(more than one box may be checked) <br />Description of Proposed Work: 966D eXCA a WILL 7-f { <br />PO K t'ARG E A,(=14E)V-r -WAT C,O U G E 9014 11 <br />;�/Contractor Fax M e-mail: iG.'ih coder o rt j. - i <br />taff will co espoad Ivith onl one designee) <br />X /or X <br />Signature of caner Signature of Contractor <br />