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Application <br />FOR — <br />Certificate of -Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Lafqette Blvd., South Bend, Indiana 46601 <br />MailingIbiaifing Address: r^-# R .. 1.4— T1_ .1 466{}1466{}1A, C- I Benc€, Indiana A <br />Phone: 574-235-9798 # Fax:574-2.35-9578 w l:nia1l;SBSJCI-IPC(Olcost -josephL'in.US <br />Website: iviAnATS46sephcotintyindiana.com/sjchp/index.litml <br />A Certified Local Govermnent <br />orwa USE 0AILY>>>>>> DO .NOT COMPIXTE. ANY ENTRIES C OjVTATNTFT.) INTHIS 130x >>>>>> 017FICE 11SE ONLY <br />Date Received M90117 Application Number JQ IL_.-. 04t0 <br />Past Reviews; rX YES (Date of bst Raiew) q1 NO <br />Staff Approval authorized by: Title: <br />Historic Commission4leview Dat& <br />F1 Local Landmark Local Historic District (Name) <br />National Landmark National Register District (Alamo) <br />Certificate of Appropriateness: <br />Tabled <br />0 Denied r Ej Sent To Committee Approved and Issued <br />DATE <br />Address of Property for proposedoik­ 5/' 1�6�718 flf/4/1) IAI 4/1(1 <br />w . i <br />Strict Nhatiber and Sirce! "'Vai'le <br />Name of Property Owner(s). (Plewse Print) <br />Address of Property Owne (s) 3 5t w 5p 1f, 15��Ap <br />Contractors) Name: )'r'viq <br />Contract Company Name: eeeVlle"W? &;,Mr <br />ContractR,/� <br />ddress: 71/-- 5 �Ke f4 i f/ (/& At ve, <br />City: Af.Phone: <br />Current Use of Building: <br />-etc.) <br />Type of, Building Construction, Ward I Fr4 lqo <br />Proposed Work: 17 In-kind 0 Landscape e -New <br />Replacement_ {trot ii)-kiiiii) []Demol4ion <br />Oww tium or. box way be clicard) <br />Description of Proposed Work: )CtPtj� FX) SA16PIZ I <br /><ZOwin;xer�ykontractor: Fax: e-mail Nj�mmqp <br />q Itke Ivill co rtsk rt r i I vile 11ce) <br />and/or <br />Signe. t1l.re of Ow r <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE :SIDE <br />