Laserfiche WebLink
Application <br />-rOR- <br />�`�' d Certificate of Appropriateness y <br />t m HISTORIC PRESERVATION COMMISSION 0 , " W a <br />1865 of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http://www.stj osepheountyindiana. com/departments/SJCHP,rindex.htm <br />p: 574-235-9798 f: 574-235-9578 e: SBSJCHPC@co.st-joseph.in.us <br />OFFICE USE ONLri»»>DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX/«««OFFICE USE ONLY <br />Date Received: b k mi 201-7Application Number: �� — ✓ �� <br />PastRevievs: ❑ YES (Date oftasrRMv ) NO <br />StaffApproval authorized by: Title: <br />j �ij / I <br />Historic Preservation Commission Review Date: �J tie 1 I Zo ( /� <br />i <br />❑ Local Landmark [�Aoeal historic District (Name) + ' o, io I " <br />t ❑ National Landmark lational Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued. <br />(Please Print)! <br />Address of Property for proposed work: <br />r r <? <br />x f tI) f,f J <br />� <br />i c`i?f: ;' <br />r <br />fl <br />�y r•'fr <br />d <br />(Street Number— Street Naine—City—Zip Code) <br />7 ' �e n -T, <br />of Property Owner(s): /1 '°I c'% <br />i f t� <br />(�?i"I/i?t% i <br />1 r <br />Phone #:" v.. / <br />—= <br />`! [. f, Aces <br />l A <br />Address of Property Owner(s); I s�'C ;_ <br />P, <br />t ,; - 11,r;ai' L. �'<4 / t L'(" l�; ;'"t y', <br />t Ca Z 3 z Lct SCt //•e �� <br />i `flJ. �`F%� <br />(Street Number— Street Name=City—Zip Code) <br />Name of Contractor(s): /l; r'tr; c ,K� r r . i. 7t 6 e:, IS Ld c r, )yzl' �' Phone #: <br />Contract Company Name: 1 U'- - �'. r r_t'rt <br />I <br />Address of Contract Company: ` r' . '�`` 4, 6r, t%L1 &✓ - . I/ii V6 <br />(Street Number— Street Name—City--Zip Code) <br />Current Use of Building: <br />(Sin/gale Family—Mzil(i-Family—Commercial—Government—Indztstrial—Vacant—etc.) <br />Type of Building Construction:t- <br />(Wood Frame—Brick—Stone—Steel—Concrete—Other) <br />Proposed Work: ❑ In -Kind ❑ Landscape E]New ❑ Replacement (not in-kind) i( Demolition <br />(more than one box may be checked <br />Description of Proposed Work:�'�G.'!Y'G" ���fit'Er I t �' il�L �iC; �' A�!'i ./ `Ll t/ :I f''e <br />D i.0 G;J, // /P.iIiI�ICf i n O/l SS %% ��/ 77J./ t? X � G,' .,OGI /"ll i r]r-i Si hC-P ✓G'/� z/ �i i'YI % fC/i/ . <br />s✓e�f �onr/�,'�,; .� �5:,>tti /�'� Carl,'r�arc�.ytJedN����� <br />i <br />Owner/Contra ax e-mail: <br />(Staff tivill co e and iv th o desi 'eq) <br />X and/or X <br />Signidure f Ow r Signature of Contractor <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />