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Application <br />-FOR- <br />Certificate ofAppropriateness <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/SJCB P/index.htm <br />p: 574-235-9798 f 574-235-9578 e: SBSJCHPC@co.st-josephJn.us <br />OFFICE USE ONL Y>>>>>>DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX-OFFICE111 USE ONLY 11 <br />Date Received: &I I u I X017 Application Number: do I I — 031L, <br />Past Reviews: ❑ YES (Dare of Last Review) ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark® Local Historic District (Name) VA'a 111 ?nik. <br />❑ National Landmark M National 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: 8 Pint Ave. <br />(Street Number— Street Name—City—Zip Code) <br />Name of Property Owner(s): Phone #: ( $ i a 1 S41 - $a o <br />Address of Property Owner(s): 813 Pods Ave. <br />(Street Number— Street Name—City—Zip Code) <br />Name ofContractor(s): 1ampc; iiiplfiry Phone#: (913) 941-9390 <br />Contract Company Name: J <br />Address of Contract Company: woo �I ym 50'11% B0l1(! <br />(Street Number— Street Name—Cit),—Zip Code) <br />Current Use of Building: _A - fo Alla L( <br />(Single Family Multi-Family—Commercial--Government—Industrial—Vacant—etc.) <br />Type of Building Construction: wood i= nA e <br />(Wood Frame—Brick—Stone—Steel—Concrete—Other) <br />Proposed Work: ❑ In -Kind ❑ Landscape ❑ New ® Replacement (not in-kind ❑ Demolition <br />(more than one box may be checked <br />Description of Proposed Work: p C1 xn �6 c) <br />ili'r°� ✓f/1n`71/v�'Q./ ��t�.1(/ � .��o , ,nom 1?„ ./,l�✓Y�' .�\2il/�i�lU <br />0 <br />Owner/Contractor Fax #: e-mail: <br />(Staff will correspond with only one designee) <br />X and/or X a_P/', j" <br />Signature of Owner Si6ature of Contract ' <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />