Application
<br />-FOR-
<br />Certi Kate ofAppropriateness
<br />HISTORIC PRESERVATION COMMISSION
<br />of SOUTH BEND & ST. JOSEPH COUNTY
<br />125 S. Lafayette Blvd., South Bend, IN 46601
<br />http://www. stj osepheountyindiana.com/departments/SJCHP/index.htm
<br />p: 574-235-9798 f: 574-235-9578 e: SBSJCHPC@co.st-joseph.in.us
<br />'OFFICE USE ONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX« ««OFFI
<br />• CE USE ONLY
<br />Date Received: 1" y/71`t-,/],, ql tf Application Number: OW
<br />Past Reviews: 9YES (Date ojLast Review) ❑ NO
<br />Staff Approval authorized by: IeL
<br />`�Title:
<br />Historic Preservation Commission Review Date: -1 01 1p
<br />Local Landmarkocal Historic District (Name) «(� KR.
<br />❑ National Landmark ❑ National Register District (Name)
<br />Certificate of Appropriateness:
<br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued:
<br />.. ....,, ...............�.,,.,,.., . .....,,..,.......,..,..,.,,,„, „, , „,.,..o„ .,. .....,.... -, .. .....,.,,.,....,,.„a
<br />p►� (Please Print) �__��t11
<br />+k Address of Property for proposed work: 13 21 c. WAYNE ST. � • J +' CCtA ij Yb15-
<br />(Street Number— Street Name—City--Zip Code)
<br />Name of Property Owner(s): T) -:� M.t r (moo ,. J t - mi sd' It 6" Phone #: S'11- 331 - 3 V11.
<br />Address of Property Owner(s): f 3 2g F- • W,%yj+i- JVU�Cj S6.4" 14vrm n eA/o E'/ 16CI,
<br />(Street Number— Street Name—City—Zip Code)
<br />Name of Contractor(s): �`i 17hv 0.10 (r— Phone #: ���"g�' -aoeZ
<br />Contract Company Name:
<br />Address of Contract Company: Ci ®a S / (2-1) 19 V e1Yh-'pAl2,1,eG L/1,, Y66a-0
<br />(Street Number— Street Name—Cit),,—Zip Code)
<br />Current Use of Building:
<br />(Single Famil),—Mzrlti-Family—Commercial—Government—Industrial—Vacant—etc.)
<br />Type of Building Construction: W0Vd r�HCgg
<br />(Wood Frame—Brick—Stone—Steel—Concrete—Other)
<br />Proposed Work: ❑ In -Kind ❑ Landscape ® New � Replacement (not in-kind ❑ Demolition
<br />(more than one box may be checked
<br />Description of Proposed Work: R)R C)Lpf- /deal r-r-'Ct-,7 I- t
<br />&CmvV�. 37-' E?C1.517ING /,-.(7Au... jQO' U'DAR &APZ TU *4,tT-
<br />(Ji tb � � T,bPS f1 �Na T "TE, - -
<br />Owner/Contractor Fax #: e-mail:
<br />(Staff will correspond with only one des' ee)
<br />X and/or X
<br />Signature of Owner Signature of Contractor
<br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE—
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