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()IJ T <br />Application <br />- FOR- <br />Certfficate ofAppropriaten,ess <br />,e HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND & ST. JOSEPH COUNTY .... <br />125 S. Lafayette Blvd., S6iith Berid, IN 46601. <br />http://www.96ostphcouni} indiaiiA.6om/departmeiits/SJCHP/index.htm <br />p: 574-235-9798 f. 574235-9578 e:*SBSJC SBSJCHPC@co.st;joseph.in.us <br />....... . ....... <br />OFFICE ilSt 6M 6 NOT COMPLETE'. - ANY ENTRIES CC&TA1NE6 B j) j C <<<<<< U& ONLY <br />Date Received: 1 3113017 Application Number. 3m oniA <br />PastReviews: YES (Date qfLWRMew) 11413006 NO <br />Staff A pprovAl authorized -by: Title: <br />Historic Preservation Commission REvJew Date: <br />ElLocal Landmark Local'HistoricDistrictiVow) Cog[ Wovip- 04fee� <br />❑ National El National RegisOr District &ante) <br />Certificate of Appropriatepess: <br />❑ Mnled ❑ Tabled F <br />Sent To Committee ❑A00t0edind issued: <br />(Please Print) - <br />z!5�r <br />Address 'of Propertyforpro'posedviork. 5- p, y t4 c- <br />(Street *Number—Street N6m6----.:City—Zip Code) r s <br />Name of Property O*fier(s): JOA y F, C--,7 r—_- A A L -b Phone #: -57*-97fw400i <br />Address ot-Property.Owner(s):. �-tsn\.4c P-5 A IS =WG <br />(Street Number—Streel Name-0tV--Zip Code) <br />Name of Contractor(s): -ST-G:,v;Z; <br />V,-/ P% c-)-4 -5 Phone <br />Contractor Company Name: L /,,S e4e 7- V fS L,/ t~2) r-? -5 <br />Address of Contractor Company: ?IoX -7(- MI-T,4AVVAIZA /,,j -1-�S <br />(Stre4 Number-" Street Name-±Cjty—;Zip 'Code) <br />Current Use of Building: 6, t-10 - i a,i1 I (-V <br />(Single Family—Utilli-1,-amilj—Commercial—Gove.rnmeni—indtistdal—Vacant—eic.) <br />Type of Building Construction: WDakb )':X 1&t,A 6- <br />.1 0 i< I CIL <br />(w6od Franie—Brick—Sione—Steel—Conciete—Oiher) <br />Proposed Work., ElIn-Kind E] Landscape [I New [3 Replacement (not in-kind) ElDemolition <br />(more Phan one box may be checked) <br />Description of Proposed Work: <br />. -A A 4 67 q Yr, -A L -- ,D m P= <br />ork <br />lnt i -r)-4 IA Pet 1) 1 0- L e --S Wace qufle(r, - gee. dfvAeJ <br />0 Je OCR�:7 '1-5 7a-Z7-g7b S-1 -7342 e7z7- <br />/_e C- L- 6-1 (_1 <br />A L . C, -j P -L7 N/ <br />A.IC-14-w -Se--77- <br />Owner/Contractor Fait #: 6 -mail: T -e v 9"' W A C -)-t -T C;) YAf A4 <br />e -P L P- C C-7 \ 1-(k 5 1) Ir w1 N C- V% j - 5 1- /�}'E ,7C. <br />xand/or X <br />St a of 6vne:!:0 Signature of Cofitracitor* <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />