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-! <br />-FOR - <br />Certiri ate ofAppropriateness <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd, South Bend, IN 46601 <br />http J/www.stj osepheountyindiana. coca/departments/SJCHP/index.htin <br />p: 574-235-9798 f•. 574-235-9575 e: SBSJCHPC t@co.st-joseph.in.us <br />n. .1. Ih. <br />OFFICE USE OtNLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««oFMCE USE ONLY <br />Date Received:51 ! 11i0 �� _ - Application Number: <br />Past Reviews: Vj YES (Date n1%ut Re.Rew) X010 1 a 0 j.� ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark ❑ Local Historic District (Name) pQ(n P0jL <br />National Landmark ❑ National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) <br />Address of Property for proposed work: fS' A S'f}LR go Aa) . S__p,j trhi It�tb <br />(Street Number— Street Name—City—Zip Code) <br />—me of Property Owner(s): R"4 Pra UiA AA 9oPV4#.5 Phone #: 363-641d <br />Address of Property Owner(s): (3(S' 115g oAna4 A. & . ,.SavrN 13fr-*. /A. 11 Lfr i L <br />(Street Number— Street Name—Cit Code) <br />Name ofContractor(s): 140me�ac.. pzpq— <br />Contract Company Name: <br />Address of Contract Company: <br />Current Use of Building: S tO b Lt, to eA h <br />Phone #: <br />(Street Number— Street Mame—City—Zip Code) <br />(Single Family—Multi Family--Commercial--Government—Industrial—Vacant—etc.) . <br />Type of Building Construction: Woob FRA;w% G- <br />(Brood Frame Brick—Stone—Steel—Concrete—Other) <br />Proposed Rork: ❑ In -Kind Landscape ❑ New Replacement (not in kind) E]Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: tot le Ere Fk"o0 PoR C A At -10 s,TL-SPS <br />AND RtFPIAce w t-rrl tgmmD��Q�1 arap�S 4. <br />erlContractor Fax #: <br />WWII correspond with only one designee) <br />-A em - <br />Signature of Owner <br />e-mail: <br />and/or X <br />Signature of Contractor <br />