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Application _ <br />FOR- <br />PLACE <br />OR- <br />• �/% • • 0 - o <br />�\LA, <br />Certificate o ppropraateness 6 z <br />eel. a HISTORIC PRESERVATION COADUSSION °m co" <br />x 1865 of SOUTH BEND & ST. JOSEPH COUNTY syr }La <br />125 S: Lafayette Blvd., South Bend, IN 46601 <br />http://www.st osephcountyindiana.com/departments/SJCHP/index.htm <br />p: 574-235-9798 f. 574-235-9578 e: SBSJCBPC@co.st-joseph.in.us <br />OFFICE <br />iiUSE <br />' ONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY <br />Date Received: lD t7iOI�t Application Number: 3016— 0606 <br />Past Reviews:. YES (Date of Last Review) lYl�� I7. �00� ❑ NO <br />1 <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: 11,. rr <br />❑ Local Landmark Local Historic District (Name) CGtOT VV GU,n e(Qe-f <br />i <br />❑ National Landmark ❑ National Register District (Name) <br />'a <br />3 Certificate of Appropriateness: <br />❑ DeniedE]Tabled ElSent To Committee ❑ Approved and issued: a <br />(Please Print) <br />Address of Property for proposed work: 17;'92- E- OaU11, u— S-twj -' 3 Sd�ntk -R[s-iA <br />(StreetlNumber-StreetName—City—Zip Code <br />Name of Property Owner(s): 14 Ck vt A ('vd\n.� to Phone #:( — - <br />Address'ofProperty Owner(s): IVtVVV4 .1 <br />(StreetNumber—StreetName—City—Zip Code) <br />Name of Contractor(s): CIow (L. <br />Phone #: ��-3-`�� o &Z. — 2 ©p} , <br />Contractor Company Name: (M 16 p- �.Un c -I rn_ <br />Address of Contractor Company: VD -021 S�"f't' L�o/u� I q 1�r L, 1�Gc r�A t Lt �t� .t I "- IP5�(7 <br />3 <br />pp (Street Number Street Name—�'ity--Zip Code) <br />Current Use of Building: St �•..' T"11' <br />_trV� > 1, <br />Single Family—M Family —Commercial—Govermnent Industrial—Vacant—etc.) <br />Type of Building Construction: wfao I .-kM P_ <br />(Wood Frame—Brick—Stone--Steel—Concrete—Other) <br />Proposed Work: ❑ In -Kind ❑ Landscape ❑ New ®Replacement (not in-kind ❑Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: ' /' - an �._ . _ Un Ztf- (I i <br />V <br />Owner/Contractor Fax #:( e-mail: LXn fc�o n'1 I/, "'p-, <br />v ► / . (ri�1i� <br />J <br />X andl/nr X <br />