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Application <br />-FOR- <br />Certificate of Appropriateness o <br />HISTORIC PRESERVATION COMMISSION 0 co' <br />of SOUTH BEND & ST. JOSEPH COUNTY Hyl *ya <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http://www. stj osepheountyindiana. com/departments/SJCB P/index.htm <br />p: 574-235-9798 f. 574-235-9578 e: SBSJCBPC@co.st-joseph.in.us <br />OFFICE USE ONLY>>>>DO NOT COMPLETE ANY ENTRIES CONTAINED IN MS BOX«««OFFICE USE ONLY <br />Date Received: oil, <br />Past Reviews: ❑ YES (nate ojtast Review) <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 />Application Number: 30 lb — 1 IS <br />© NO <br />Title: <br />❑ Local Historic District (Name) NOfh 'R. Ynp;gpY <br />National Register District (Name) <br />El <br />❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) \ c �/ f <br />Address of Property for proposed work: i Z 1�1 d J� • .� (j�,� S�tj�, ('/� 7 1 <br />(Street Number—Street Nam —City—Zip Code) <br />Mme of Property Owner(s): D0 E © d`1 eNL Phone #: 574 " 2-'14 —qq2_j <br />ll l`` 11 <br />Address of Property Owner(s): 012- 1-k ,'Si - 3 dScM h S o v+t' V5CAd '-I� O <br />NI(Ai�f d(� aQ$� 5, u,'il �S1Ma (Stree?Number—StreetName—City—Zip Code) <br />Ce(l6av;lie, 111 49j19„ <br />Name of Contractor(s): �ar A.5v_t <br />Phone #: 5 7 4+14/`F' <br />Contractor Company Name:�i <br />Address of Contractor Company: 32V�45 3kc_cise,1//c+ ?`3 y a_ LI%A t41e_W' C4�P11% 11Jp_ IN( Lt(.SS"Z, <br />(Street Number— StreeName—City-1_ Code) <br />Current Use of Building: S\! <br />ck t e' <br />(Single Fancily—Multi-Family—Commercial—Government Inditstrial—Vacant—etc.) <br />Type of Building Construction: tjQoCl 7-rab'1'1 &-- <br />(Wood Frame—Brick—Stone—Steel—Concrete—Other) <br />Proposed Work: ❑ In -Kind ❑ Landscape FfNew ❑ Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) <br />t r <br />Description of Proposed Work: C! , <br />miner/Contractor Fax #: , 7 � ��y^.3St// e-mail: <br />X and/or <br />Signature of Owner <br />4"e -r_.l u ca °n <br />X <br />Signature of Contractor <br />