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b� 1c`atOak <br />ion <br />e,l- <br />`�;..::..;�3 <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/SJCB P/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«« <br />«OFFICE USE ONLY <br />Date Received: Aaal dol I Application Number: 3M — 0339 <br />Past Reviews: ® YES (DateajLastReview) 01Ll bo 16 � NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Co ssion Review Date: <br />Local Landmark F] Local Historic District (7vame) <br />F] National Landmark ❑ National Register District (Nage) <br />Certificate of Appropriateness: <br />Denied Tabled E] Sent To Committee Approved and issued: <br />IAV <br />_ <br />(Please Print) J� - pay <br />' <br />Address of Property for proposed work: C�l� <br />1 (Street Number—Street Name—Cit)—Zip Code) <br />Mame of Property Owner(s)• s�� &4 pal1, 6 44 Phone #: <br />Address of Property Owner(s): <br />(Street Number Street Name—CityZip Code) <br />Name of Contractor(s):Cl_ 2- Phone #• (y °J " <br />Contractor Company Name: Reek rV P_ t Aso , <br />Address of Contractor Company: / �l) ��' VV aS ►t 5tt <br />_ - �. %���✓J / <br />t <br />(Street Number4Street Name—City—Zip Code) t <br />Current Use of Building: <br />C �s Z��/�14t%✓1 <br />(Single Family—Mitlti-Family—Commercial—Government Industrial—Vacant—etc.) <br />Type of Building Construction: f v jk — <br />` (Wood Frame—Brick—Stone—Steel—Concrete—Other) <br />Proposed Work: In -Kind )N Landscape New Replacement (not in-kind) Demolition <br />(more than one box may be checked) j� 1 <br />Description of Proposed Work: <; 0 <br />Owner/Contractor Fax #: e-mail: l _{�ii1 eq W�r <br />plus-1 , c4M <br />t <br />X - and/or X Signature of OwnerSign tur <br />