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��� t�uTtr j1 Application <br />tj C `Pyl�t'tlr" tij - FOR <br />Certificate ofAppropriateness <br />t � ti�lt'�{G.J�% � • L <br />PRESERVATIONV . n+' •C t•..�2.._l� HISTORIC COMMiSS10N • r <br />�w <br />�'�,X tsa , �,•, orSOUTH BEND & ST. JOSEI'fl COUNTY <br />125 S. Lafayette Blvd., South Bend, 1N 46601'. <br />hUp:itvtv�ti'.stj6sephcolntyindi nrt�.c nnurJ�puu m_tttstSJCi-ifi ndca.httn <br />p:574-235-97193. f.574-235-9578 e: Sl35iC11YC{Ft?cq.st joseph.tn.tn <br />OFFICE llvE ONt,r»»»l10 NOT Cohn `LF.TF ANY ENTRIES CONTAINED IN T11 IS tIOX«««OFFICF VSE ONLY <br />Dntc Received: Application Number: <br />vast Reviews- ❑ YVS (nmr�q)f.+nx.rfm} ❑ NO <br />StalTApprm•al authnr)zcd by: _ _ Tillm <br />Ilistorie 1'rescrvalian Commission Review Dale: <br />❑ I.acal Landmark ❑ Local Ilistm is Dimicl IN d) <br />❑ Nationall.andmarh ❑ National Rc9isterbistrictim-I _ <br />Certificate orApproprlatcncss: <br />❑ Denied D Tabled ElSent'ro Committee ❑ Approved and issued: <br />i '• i i i i i iii J <br />(1'lcarse1'1int) l' A <br />Address of Property for proposed work- lo(v M.Mita it1 �KU <br />4-6'rs STH SWfl s W 4 6601 <br />(Str•eet Nttl))bcr Strect Atamc—(.'ity •71p Code) <br />---IorProperty Olvncr(s): J IJeV'lIApR'►e'4 Ll"6 Phonefl: M'C+'LY.O <br />��I�aDl.f4.1'D� <br />Address of PropertyOwncr(sl: ��� Ila.So se�"6vrt ©{VU.1 s".1pe zoo+ 'C 88r'I <br />�-�+ (.SlrectNnttuber—SbcetAIame• 17,70 -7ipCodc)) A a' /� <br />Name of Cantractor(s): 11r'r'1 Chex- f71t er+'Pl�t°•41CtL ' Phone #: r;74..CJgZ.6DD0 <br />6.0�J t <br />Contractor Company Name: arta,4na t5igr,-6omi�?i1L&I <br />Address of Contractor Company: .lo&z5 56 e i"romd i,to i � mos, t W 4�s'5o%f <br />(Bare"et A'ernhor• Cart Atsne Citi-7Jp t:adcl <br />Current Use ol'Bullding: CAmmC4-"'1A 1 <br />ring1cFojn11jx M7rlti-Family/Commercial <br />! tin1CT17lneill—Ltdnsrrlal i'acelm etc) <br />Type of Building Consiructinn: vT iC/C��t'Q a -!• R� <br />(lihnrf Frrtms—Tri; k- Slane -StrcJ C:ancrete 01he1) <br />Proposed Work: ❑In -Kind ❑ Landscape © Ne>w34 ❑ Replacement (totbrkind) ❑ Demolition <br />(store than one bar may he checked) <br />Description or Proposed Warla *e -e, a AA e--keA <br />O+vnerlConlraclorFax #i;�` - - - - canall: !-�• � .,-"—___..-, _ <br />X <br />Signature of Oivncr "tin tr cf attar <br />—APPI,IC.ATION IWQUIREMENTS AR LISTED ON REVERSb: SiDI <br />