Laserfiche WebLink
Ll <br />Application <br />-FOR- <br />Certificate of FOR <br />HISTORIC PRESERVATION COAUMSSION <br />of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http://www.stjosephcountyindiana.com/departments/SJCBP/index.htm <br />p: 574-235-9798 f. 574-235-9578 e: SBSJCBPC@co.st-josephJn.us <br />OFFICE USE ONLYS»»>DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY <br />Date Received: 0) l2 I go l I Application Number: L1101 1 — 0 ,� 0 G <br />Past Reviews: ❑ YES (Date of Last Review) <br />Staff Approval authorized by: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark <br />❑ National Landmark <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled <br />❑ NO <br />Title: <br />❑ Local Historic District (Name) <br />© National Register District (Name) �,Q, d 90 0 ne J ,nA d M (1 E <br />❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) moi_ Q M� <br />Address of Property for proposed work: s v `� �v� �`"'C� �� ��` k,G$+-X <br />r/(Street Number— Street Name—City—Zip Code) �� �/ parrs icc �.^-i a -e - <br />Name of Property Owner(s): A V l9`�. �l°i-J j l �� k5_4 Phone #: 2-`3� 5 �] (T <br />Address of Property Owner(s): -? Z (U.=- <br />t� (Street Number— <br />(Street <br />�N,(acme—City—Zip Code) <br />Name of Contractor(s): l ` t� 1(5� 011 nn iL��� c'cn ��',10 j�Vnl v1 Phone #: <br />Contract Company Name: ��.{.�"l� P�- �1`-� t^'LJwI tih C:r1 �►v I (�`f`�1 �� iz y ,s C:4 `V (C E l.O li e� 6 riCV10' . <br />hh c LtLI�L�+f' �` pp V ll ✓�0�'�G�v�1. `ito� <br />Address of Contract Company: 7-1 �_ Yt <br />r ( (Street Number— Street Naine­0ty—Zip Code) <br />Current Use of Building: <br />(Single Family—Multi-Family—Commercial—Government—Industrial—Vacant—etc.) <br />Type of Building Construction: �1�� �� I ° �� t1CC�°- °�- S`� ge.1 �f�s , St Q4i w j & Pte, A5i f <br />s' <br />(WoodFrame—Brick—Stone--Steel—Concrete—Other) APA (0-tt&Slope,/ i ticrLi' <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: ne cLtm � 'coJE4y o <br />�p N aw staq e. �e,w <br />g,v%,Al S &4 -PV. 6t.4- k/% " C,4_*0, Uc 6 AL S i 0, k`F( y Fo 5+&.qi e e -W bpaa�e-s <br />W t` o ,n e. a--�e_ tP cl C. 5 P_ 5 +Za ,� V � M ov-,-- t ti'i VV -tate. , S e &1-1� ct,e-,ln e <br />Owner/Contractors#: �g `' `a 0 e-mail: t 6 v1 dt (1 <br />(Staff will correspond <br />with only ohne designee) <br />X ' (/�J-X� LYP1 5 and/or <br />s �t`� <br />Signature of Owner �a ; �&Mf Signature of Contractor �rSh C� (�� IVl��SSfl� ��%-,%4 � <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />