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Z <br />45oUTN` <br />B� Application �0MM14S1�"fRS <br />0 01101ib/it'�d <br />� -FOR <br />.. .. ♦ x u <br />w \\PEACE%j Certificate ofAppropriateness o - <br />`t .>a HISTORIC PRESERVATION COMMISSION <br />x 1865 x of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http://www.stjosephcountyindiana.com/departments/SJCB P/index.htm <br />p: 574-235-9798 f. 574-235-9578 e: SBSJCBPC@co.st-joseph.in.us <br />OFFICE USE ONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY <br />Date Received: 31101 D 0 I7 Application Number: a0 17 — Oa ( 0 <br />Past Reviews: ® YES (Date ojLast Review) gill a30 Ito ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: II <br />❑ Local Landmark Local Historic District (Name) weof NO4h 9h o e <br />❑ . National Landmark ❑ National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />(Please Print)14 p-,5+ � S ko ee- b <br />Address of Property for proposed work: W R <br />(Street Number— Street Name—City—Zip Code) <br />Name of PropertyOwner(s): ?AV L' (00A[, fluff t 1?0ItE &Z6b Phone#: 57q 2 7/ 8f 90 <br />Address of Property Owner(s):, 32-5 title &L_Ae,r 4, tlS n a L�__✓ .�1w �ti is -e" <br />�^ BB r (Street Number— Street Xame=City—Zip Code) <br />Name of Contractor(s): 7e (� Phone #: <br />Contract Company Name: <br />Address of Contract Company: <br />(Street Number— Street Name—City—Zip Code) <br />Current Use of Building: 1 1 <br />(Single Family—Multi-Family—Commercial—Government Industrial—Vacant—etc.) <br />Type of Building Construction: Wood F.,- a "^.e <br />(Wood Frame Brick--Stone—Steel—Concrete—Other) <br />Proposed Work: ❑ In -Kind 19 Landscape ❑ New ❑ Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work:LcAtjL 4ci.t °'t� otSu 1+ rt'otvjay <br />re &AN Ie P �'� ct, a / Gu o' <br />ttiQ l� <br />L4/ 1 –'/Ca /0/4 a k/A <br />1�% C�1-0e ri P_-,tA <br />ilk <br />A S' NA& %� k u�rx /t°� wa� ��/a+•+ �� l� �es'�ev� C7P�O c �1(%(Q <br />Owner/Contractor Fax #: e-mail: W o ('d &h r a S <br />(St 1 correspond with/ o�ngly one�designee) <br />X and/or X <br />Signature of Owner Signature of Contractor <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />