Laserfiche WebLink
Application <br />-FOR- <br />Certif irate of Appropriateness <br />HISTORIC PRESERVATION COMMISSION I�Rv of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, 1N 46601 <br />http://www.stj osephcountyindiana.com/departments/SJCHP/index.htm <br />p: 574-235-9798 f. 574-235-9578 e: SBSJCHPC@co.st-joseph.in.us <br />OFFICEUSEONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX --OFFICE USE ONLY <br />Date Received: ) 01 Iq I t7] 01(, Application Number: 301 b — W H 0 <br />;Past Reviews: YES (Date ojLast Review) �,a I 1 NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: <br />F] Local Landmark <br />National Landmark <br />Certificate of Appropriateness: <br />El Denied Tabled <br />Local Historic District (Name)} rlei�� dP. <br />��—' National Register District (Name) <br />Sent To Committee Approved and issued: <br />(Please Print) 21C <br />Address of Property for proposed work: l <br />Name of Property Owner(s): <br />Address of Property Owner(s): <br />Name of Contractor(s): <br />Contract Company Name: <br />Address of Contract Company: <br />(Street N t ber— Street Name—Cit)—Zip Code) <br />Xr1 �� Phone#: <br />(Street Number— Street Name—City—Zip Code) <br />Phone #: <br />(Street Number— Street Name--City—Zip Code) <br />Current Use of Building: <br />(Sing mily—Mztlti-Family—Commercial—Government Industrial—Vacant—etc.) <br />Type of Building Construction: <br />(Wood Frame Brick—Stone—Steel—Concrete—Other) <br />Proposed Work: In -Kind Q-fa-ndscape D-fq-ew Replacement (not in-kind) Demolition <br />(more than one box may be checked). <br />Description of Proposed Work: <br />V � <br />Owner/Contractor Fax #: e-mail: '�� �� ��` 0 eon <br />`(Staff wilcorrespond with onl ne designee) <br />_ — and/or X <br />Signature caner Signature of Contractor <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />