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•J <br />Application <br />FOR - o sa <br />Certificate of Appropriateness o " <br />HISTORIC PRESERVATION COMMISSION G <br />x 1865 x of SOUTH BEND & ST. JOSEPH COUNTY °,yt *loco <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: SBSJCBPC@co.st-joseph.in.us <br />OFFICE USE ONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY <br />Date Received: ( 7 Application Number: J017 �L� <br />Past Reviews: 10 YES (Date afLastReview) 1oao((, ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: <br />® Local Landmark Local Historic District (Name) Ed`1 wales <br />ElNational Landmark FillNational Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) 8/6' <br />l� /J t <br />Address of Property for proposed work: Zj Arti h A v -t , s'g I <br />- AA 'f& 6 0 1 <br />-� `� (� f(StreetNumber—StreetName—City--Ziproode) <br />� <br />Name of Property Owner(s): : 50 n 1 T t E J.Ce (`QF- Phone #: 303 " (O 1:3 3 <br />Address of Property Owner(s): 1514r� <br />(Street Number— Street Name—City—Zip Code) <br />Name of Contractor(s): (P_ V Phone #: <br />Contract Company Name: <br />Address of Contract Company: <br />(Street Number— Street Name—City—Zip Code) <br />r <br />Current Use of Building: <br />i r� ' y <br />(Singe Family—Multi-Family—Commercial—Government Industrial—Vacant—etc.) <br />Type of Building Construction: gZA(_ <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: 2 / t k 7 ��*��'�� CJ rhe r 5 0/_ <br />S'f-,(� L,-e,-� rtke r --10 rev le- c < 2 9 ` x zl �,Jft, Aev S <br />,45 ecce 2 -F• t�.(LW +( /9A,' r' o 40 - _/i_ D n t is -P 4 O t.t"..0— <br />d <br />Owner/Contractor Fax #: e-mail: <br />(Staff will correspond w)lp only one designee) <br />X and/or X <br />Signature of ter Signature of Contractor <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />