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Application <br />-FOR- <br />Cerii icate of Appropriateness <br />_1A HISTORIC PRESERVATION COMMISSION <br />YsbS of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46501 <br />http:/Avww.stjosephcountyin4iana.coax/departrnents/SJCBP/indexjltm <br />p: 574235-9798 f: 574235-9578 e: SWCHPC@cost }oseph.in us <br />. „, . , <br />aFMC9 UW OAT 15— »> 10 carr r.nMTT TTE ANY EN 7 RM9 CONTAMD nv TMS sox«««UFFIC F USE awY <br />- Date Received: ( 1 I @017 Application Namber: 3 017 — 0 301 <br />Past Reviews: YES. Mxe.afLastR_k_) NO • <br />LIQ-5tc(-.'�73tr VQAn;fe! <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: ! -1 <br />LocalLandmark Local Historic District (Name) i� I ll P/410/1(1 <br />National Landmark National Register District (Name) <br />Certificate of Appropriateness: <br />Denied Tabled D Sent To Committee Approved and issued - <br />(Please print) <br />Address of Property for proposed work. P4AtF r <0077- - 13 E6t31_)- Ike '0�6,CJl <br />(Street Number--StreetName—City—ZipCode) <br />Name of Property Owner(s): jye&► �/r/ %�r)nJ �S m IC-�% D£S Phone If., I -S-A 1A I4OJIc <br />Address of Property 0wner(s): S37 S -5e' V Ii L%aGLz, M )61+1 6`AX7 C ) i_ 1 1 j tj Yea. -L 13 <br />(StreetMmber—;StreetName—City—Zrp ode) <br />Name of Contractor(s); hi?A-P— e A -U ER— Phone #: 2 A/ 0202 i " -5a)4 <br />Contractor Company Name: Q91,0 b/i <br />Address of Contractor Company: %53 7 Ed'] C7 G- / e - G C -.f- M i G i -1 0 C 1 � � l 10 L/ bs% D <br />(Street Numb)r— Street Name—Cify--Zip Code) <br />Current Use of Building. FA7n / L'/ <br />(Single Family --Multi Famib—Co/nmercial—Government Industria�—Yacant—ele.) <br />Type of Building Construction: L000 b ��.-i�7"✓Z, <br />(Wood Frame Brick—Sfone--,Steel--Concrete—Ocher) <br />Proposed Work: In I{ind Landscape E] New 0Repiacemtent (not in-kinco ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: P.e S 1Z EA-0.)EV r-"—, A I .r &J I/VDO UJ S, <br />S!V 40 ru/)Iva) LZ <br />P-A-VILC- <br />��r�.3,u� �t�....r�tV�% d- �t✓� �r�2s �c� cd��. ar - 3b �,vc.�- tv�lQ r'�, <br />OwnerlContractor Fax 0: a -mail: /Y► � �CtaU � t ` % �l-f �, J � t l . C d /i L <br />X, _ !lflrlJ and/or X,I�1/11 <br />Sig�atu of Owner Signature of Contractor <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />