Laserfiche WebLink
Application <br />-FOR- <br />Certificate of Appropriateness <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 466(11 <br />http://www.stjosephcountyindiana.com/departments/SJCHP/index.htm <br />p: 574-235-9798 f. 574-235-9578 e: SBSJCHPC@co.st-josephAn.us <br />OFFICE USEONLI»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN TIIIS BOX«««OFFICE USEO,VLY <br />" <br />� 1� (� \ <br />Date Received: t` ) t t (aY" �� 1 1 b Application Number: <br />Past Reviews: YES (Date of Last Review) ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark Local Historic District (Anme) CIS A 1p1 h <br />❑ National Landmark National Register District (,,vame) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />TI <br />(Please Print) yy� <br />Address of Property for proposed work: ��(/ 10AAZR_* A&C, 5&2 2?4: R '1_ G 10 ,L'f?&AtZA 66e' /L <br />(Street Number— Street j\lame—City—Zip�Codee) <br />���f%-75/ <br />Name of Property Owner(s): v/,V 1? /& � 611 ���' `)r-' (' Phone #: � f- <br />Address of Property Owner(s): L%C6 q Alke.7`A�pj1 j1jg <br />(Street Nrmtber— Street Nanie—City—Zip Code) <br />Name of Contractor(s): �it'/�t'11il) Phone #: <br />Contract Company Name: , J -e,44 <br />f t'Cn �Xr i/y17 <br />Address of Contract Company: %5%1 Ko I• - 27Y . -.aft• 4%j7'ej <br />(Street A'unr�&1 •eet A'ame—City—Zip Code) <br />Current Use of Building:S�/01' 4 e - <br />(Single Finnilj-llfulti-Family—Cominertial—Government—Industrial—t'acanl—etc.) <br />Type of Building Construction: /VIA <br />0I ood Fi•anie—Brick—Slone—Steel—Concrete—Othet) <br />Proposed Work: ❑ In -Kind ❑ Landscape ❑ New ❑ Replacement (not in-kind) emo ition <br />(more than one box may be checked) <br />Description of Proposed Work: /, �c7lfl f/� 7Z) <br />,06A115 JJ: �f>1,r�:��1�°nus-T'-`%� Gl�i�/ <br />���lstc�GdGC-V/Lvn—1 �C'vvtSrZ <br />Owner/Contractor Fax #: / mail: <br />(Staff illill ccs respond with only one designee) <br />X �--� %l and/or <br />Signature of 6wner <br />fluh �/LL !?4 <br />X <br />Signature of Contractor <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />