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Application <br />. FOR - <br />Certificate 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 osephcountyindiana.com/departments/SJCHP/index.htm <br />p: 574-235-9798 E 574-235-9578 e: SBSJCHPC@co.st-josephJn.us <br />OFFICE USE ONL YS»» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFIC ' „ <br />E USE ONLY <br />Date Received: Application Number: �01U — OW <br />Past Reviews: YES (Date of Last Review) �0 - 1031 ❑ NO <br />Staff Approval authorized by: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark <br />❑ National Landmark <br />Title: <br />504em hes 1q, ao e <br />® Local Historic District (Name) ' i i,q ej&AA <br />❑ National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />........ ..... .. ,. .,,,,,,,, „. ,,, ■ <br />(Please Print) (� <br />Address of Property for proposed work: 901 SIL. (, J r�� (��� �V, "� �"� -1 l� b \ <br />l (Street Number -L --Street Name—City—Zip Code) <br />Name of Property Owner(s): fisl�.4P_ IYI�T I �FCLE� 54,E K,_ Phone #: CF� � —W O <br />Address of Property Owner(s): Ile-.> f? t.'j f!2 -ft (0<(* S6, t -�L 6( 6 6 Ci \ <br />(Street Number— Street Name-City—Zip Code) <br />Name of Contractor(s): kh LA t (i Of. ,y, e_ pec l I` Phone #: _ ' —7 —7 (O 2 <br />J <br />Contract Company Name: / (� <br />Address of Contract Company: (/%�� IG l(% Fa _N LC <br />(Street Number— Street Name—City—Zip Code) <br />Current Use of Building: <br />(Single Famil //Multi-Family—Commercial—Government—Industrial—Vacant—etc.) <br />Type of Building Construction: 't l Ot`l �! �> ti► <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: IJ i <br />Owner/ ntr ctor Fax #: <br />(Staff w' 1 co espond wit my a esignee) <br />X <br />Signature of Owner <br />—APPLICATION R <br />e-mail: P/ S (-v 1 el (�_ �6 & . Co "� <br />and/or X <br />Signature of Contractor <br />;NTS LAItE ISTED 0 SIDE— <br />