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.j <br />Application <br />- FOR - <br />Certif icate 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/SJCHP/index.htm <br />p: 574-235-9798 f: 574-235-9578 e: SBSJC1PC@co.st-josephJn.us <br />OFFICE USE ONLYS»»>D ENTRIES O NOT COMPLETE ANY E S CONTA I " 11 ' . <br />INED IN THIS BOX«««OFFICE USE ONLY <br />Date Received: 911101-7 Application Number: 'DO 17 — M 10, <br />Past Reviews: R71 YES (Date of Last Review) I I O ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark ® Local Historic District (Name) Caor TIO'P_Pf <br />❑ National Landmark ❑ National Register District (Name) 1 <br />Certificate of Appropriateness: <br />❑ Denied ❑ TabledElSent To Committee ❑ Approved and issued: <br />(Please Print) i�, 1 / � Sfln,� J <br />Address of Property for proposed work: (Li 1 -2W �. P _ __a <br />(Stree�Number— Street <br />�Name—City—Zip Code) <br />Name of Property Owner(s): A,.-- C -Phone #: N-09 n l "1"OI <br />Address of Property Owner(s): y 1 t. ..,.1? _ j V 3 nj <br />(Street Number—Street Name—City—Zip Code) <br />Name of Contractor(s): �� �;,Q t, �� �, L ., e� Phone #: <br />Contract Company Name: M {,t� ,IN- l?rzt a•� <br />Address of Contract Company:3AC <br />t/ ( r<7) L Alga L I t,� 1 _ _T/ V I U7 <br />(Street Number—Street Name—City—Aip Code) <br />Current Use of Building: J 1+^ C P <br />Ingle Family—Multi-F ily—Commercial—Government—Industrial-1 <br />Type of Building Construction: 1n c," <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 />Descri do of Proposed Work: t Acq <br />X,+L �j �fltic,., a �� ski°.s1e� Z,i� r�o�,oCA. <br />_�i�:R�VtSible T.t.r��.. �/ �A,vP_ -i�✓� fes., �n 1rQ/i1 Ia Inn.-�L <br />04to-,O,OtO T P6 w.e^,Lr&/t ,o <br />e, CPfe/ cli le P-1 e « -r4 Vc� T p <br />caner/Contractor Fax #: edmail: f I <br />(Staff will correspond with only one designee) <br />4 <br />X and/or X qAA , <br />Signature of Owner Sign re of Contractor jr <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />