Laserfiche WebLink
Application <br />-FOR- <br />Certificate of Appropriateness <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 f. 574-235-9578 e: SBSJCHPC@co.st-joseph.in.us <br />OFFICE USE ONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY <br />Date Received: WR3/ 17 Application Number: �O 17 — 0 6 a3 <br />Past Reviews: © YES (Date of Last Review) <br />Staff Approval authorized by: <br />Historic Preservation Commission Review Date: <br />® Local Landmark <br />❑ National Landmark <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled <br />i <br />1olm/ 2011e ❑ NO <br />Title: <br />❑ Local Historic District (Name) <br />❑ National Register District (Name) <br />❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) <br />Address of Property for proposed work: ��°,,,�N - <br />(Street Number- Street Name -City -Zip Code) <br />Name of Property Owner(s): { xnR L-t�Pc- 7 <br />Phone #: <br />Address of Property Owner(s): j C-) ;LN,4 DL/0 ��i{ t� �� , Sit" j�,� � 'r-tv Lit -1_-4, <br />(Street Nztfiber-Street Name -City -Zip Code) <br />Name of Contractor(s): �r e-r�R_ Lj-)4r-_ i <br />Contract Company Name: <br />Phone #: iL4 - 9:SD0 70J�_ <br />Address of Contract Company: Sn M _ A& A- RZ) V,'_, <br />(Street Number- Street Name -City -Zip. Code) <br />Current Use of Building: <br />(Single Family-Mttlti-Familj,,LCommercial-Government-Industrial-Vacant-etc.) <br />Type of Building Construction: ( K <br />(Wood Frame -Brick -Stone -Steel -Concrete -Other) <br />Proposed Work: ❑ In -Kind ❑ Landscape Z New ❑ Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: _� ®Q W& i -A 7 ®n 6 , R(S �(� fuP�y%U In iA)( <br />RX24 Ij At- 4- is -1 to ts-T ^ ArC-i� <br />_ <br />� D X\ f Le! -1-4. t0_0f V___ <br />Owner/Contractor Fax #: <br />(Staff will correspond with only one designee) <br />X [l, �,-bl A& /,0 9i.L <br />Signature of Owner <br />e-mail: <br />and/or X <br />Signature of Contractor <br />-APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE- <br />