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.r- <br />Application <br />-FOR - <br />CeYti acate of Appropriateness <br />HISTORIC PRESERVATION COMMISSION ° ` o <br />1865 : of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http: / /www.st osephcountyindiana. com/departments/SJCHP /index.htm <br />p: 574- 235 -9798 f: 574 -235 -9578 e: SBSJCHPC@co.st-josephJn.us <br />y.n... ... ...m......n1... I .iiI ...I. d.0 i... i i 111. A.. 1.- 111...1.., i i..... iWiii 1i.,I,.11 k'.ni i.. i I . ... ...i.I.i...Y.fuil�l��. <br />OFFICE USE ONLY» » »DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX < << < << OFFICE USE ONLY <br />Date Received: 13 1 Application Number: 301 — o 0 3 A <br />Past Reviews: ❑ YES (Date of Last Review) NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: <br />Local Landmark El Local Historic District (Name) <br />❑ National Landmark ❑ National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled El Sent To Committee ❑ Approved and issued: <br />(Please Print) /� I <br />Address of Property for proposed work: 6 01 E % G'�`w�' f 1,L 1A �la J�3CJ <br />--� <br />(Street Number -- Street Name — City-' -Zip Code) ' <br />Name of Property Owner(s): I/,;. > SEv4- Phone #: 5 L/ v <br />Address of Property Owner(s): Z5 . /q 1 trT T 141 �/ I /Z— <br />(Street Number — Street Name — City —Zip Code) <br />Name of Contractor(s): Phone #: <br />Contractor Company Name: <br />Address of Contractor Company: <br />(Street Number— Street Name —City —Lip Code) <br />Current Use of Building: /�1YLPT <br />(Single Family —Multi Family— Commercialovernment Indust) 1'acant —etc.) <br />Type of Building Construction: Ick <br />(Mood Frame Brick — Stone — Steel— Concrete —Other) <br />Proposed Work: ❑ In -Kind J&andscape New ❑ Replacement (not in -kind) Demolition <br />(more than one box may be checked) ,( <br />Description of Proposed Work: <br />��5"t.�'�' ©�.�) ` .0 C ✓�� 6�t�- <br />�'fnetJl�/� �ra,l�G �1/I��l t A,0 _ R!O d15 'r.�� 1 ©a. ivzrt'i�. AD-7 <br />£� B '�S fad ✓ /uc�s�isl. ENH4A1fr' ©WOOk" Ge7`TA60 1�AAlfrt_ <br />Owner /Contractor Fax #: e-mail: <br />X f°�` =� and/or X <br />Signature of Owner Signature of Contractor <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />