Laserfiche WebLink
uci ue eu i o i e..ujt m rcaymona fames rinanoai o / page "i <br />Application <br />- FOR - <br />Certificate ofAppropriateness <br />'< WHISTORIC PRESERVATION COMMISSIONoof SOUTH BEND & ST. JOSEPH COUNTY syr J'i'e <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />hrtp://www. stjosephcourityindiana.c,om/departments/SJ CH P/index.htm <br />p: 574-235-9798 f: 574-235-9578 e: SBSJCI4PC@co.st-josephJn.us <br />OFFICE (ISE ONLt"5,»»>2jL'gT CVOMPLETE ANV F.NTWFS CONT INED IN THts R0Xu <« 0F/F1C.E USE ONLY <br />Date Re, eived: - "i �._ _ Application Number. ION -Fn <br />Fast Rniews: VES (Dare ofauoedew) _— a01` _ 1005 0:.•-.._.__..� ❑ NO <br />Staff Approval authorized by: <br />Historic Preeervatton Commission Review Date: <br />❑ Local Landmark <br />i ❑ National Landmark <br />Cerdfi to of App ro riateDeM <br />DtniedElTabled <br />Titie: <br />9 Local Historic District g amc, <br />❑ National Register District(xvme) <br />❑ Sent To Committee ❑ Approved and issued: <br />(Please j'rinr) `.�j rn � <br />Address of Property for proposed work: /!'! �a��' ��—L�1��!+�1_ <br />(Streetumber— Streejjt Name—{'i4—Zip Code) r� <br />�iamt of Property Owner(s):�.--� C2,1 Phone it: <br />Address of Property Owner(s):-SA-y-4P <br />r - �.—(r-- (,Street N,umq ber— Street R Name---City—Zip Code) <br />NaIne o I Cc n tra cto r(s): B, LlGM ��_W111' i1) 414e49 _ Phone #: jWr- '97 �r <br />Contract Company 1Vame:(�s ip�)a ` S e� � <br />Address of Contract Company: 50471 (�i'.l�1S R —7 _/V 7th✓ <br />(Street Number—,Street Name—City—Zip Code,) <br />Current Use of Building: ! S_ i tj la _ <br />(Si to Family -•Mutt Family—Commercial—Government—Industriaf--Vacant—etc.) <br />Type of Building Construction: <br />(Wood Frame --Brick Stone-Meet—Concrete—Other) <br />Proposed Work: Q In -Kind ❑ Landscape ❑ New � Replacement (not in-kind)❑ DgmQ_lizion <br />(more rh in one box nut, be checked) --ame APP2Ltr"C _) Zl sZ <br />Vescrip' ion of Proposed Work: ".P _ pff� NQQ_o on. A16rte sr hal &- <br />�Q31.t a C. "G I i16 <br />!! W- M <br />Owner/Contractor Fax #: 4( <br />(Stalj'wi t corresrpond with onto one designee) <br />e-mail: <br />n <br />&D OYI <br />SCO -1 <br />X 15 - t e / end/or X 0- <br />Signatu of Owner Signature of Contractor <br />