Laserfiche WebLink
45013T8� Application <br />- FOR - <br />;:, C'ertificate ofApproprzateness <br />�`e m� HISTORIC PRESERVATION COMMISSION <br />xass 7j of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http://www.stjosephcountyindiana.com/departments/SJCHP/index.htm <br />p: 574-235-9798 f 574-235-9578 e: SBSJCBPC@co.st-josephJn.us <br />OFFICE USE ONLFS»»>DO NOT COMPLETE ANY ENTRIES CONTAINED IN TATS BOX«««OFFICE USE ONLY <br />Date Received: _ Mail Application Number: W6 <br />- Past Reviews: ©'YES (oau of Lost Review) 3013-01W ❑ NO <br />Staff Approval authorized by: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark <br />❑ National Landmark <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled <br />Title: <br />9uon @0, ;Poll, <br />Local Historic District pvame) Uncal nu►ai1 � Gapj� <br />❑ National Register District {Name) <br />❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) ,t <br />Address of Property for proposed work: <br />(Street Number—Street Name ity— ip Code)'�� �t <br />Name of PropertyQwner(s): i`'A^�( C} - ��'�( Phone#: <br />Address of Property Owner(s): o��nf��.��.J <br />(Street Number— Street Name—City--Zip Code) <br />Name of Contractor(s):ir-An �iC.� Phone #: <br />Contract Company Name: / <br />Address of Contract Company: - (t{`C;Y �✓ `-1Go'C� <br />N <br />(Street Num — Streei Name—Ci ip Code) <br />Current Use of Building: <br />(Single Family—M(uIll Family—i ommercial--Uavernnrent Industrial—Vacant—etc.) <br />Type of Building Construction: — -kctn.Sl. <br />(Woad Frame—Brick— Stonn"teel—Concrete—Other) <br />Proposed Work: ❑ In -Kind ❑ Landscape ❑ New (not in-kind) ❑ Demolition <br />(more than one box may be checked ;eReplacement <br />_ ,( <br />Description of Proposed Work - <br />C' % � j <br />ork:Cj *C"!,. <br />Owner/Contractor Fax #: Q5. -S '" S e-mail: <br />(Staff will correspond with only one designee) <br />rv' and/or X <br />Signa a of er =a Signature of Contractor <br />APPLICATIO UIREMENTS ARE LISTED ON REVERSE SIDE— <br />