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HISTORIC PRESERVATION COMNIISSION <br />OF SOUTH BEND AND ST. JOSEPH COUNTY <br />County—City Building,, South Bend, IN 46601 <br />http:/hvwtv.stjosepheounq indiana.com/438/Historic-Preservation-Commission <br />Phone: 574/235.9795 Fax: 574/235.9578 <br />Email: SBSJCIIPC@sjcindiana.com <br />Timothy S. Klusczinsid, President A Certified Local Government of the National Park Sertiice Elicia Feasel, Executive Director <br />APPLICATION FOR A — CERTIFICATE OF APPROPRIATENESS <br />OFFICE USE ONUS»»>DO NOT C011PLFTF ANY ENTRIES CO\'TAI\'ED Lei TIUS BOX«««OFI7CEUSE ONLY <br />' <br />I <br />Date Received: 11 1 t 'Z"t -7 Application Number: 2-01 1100'A <br />Past Reviews: DYES (Date oft ast Reriett) ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark ❑ Local Historic District (Vane) <br />❑ National Landmark ❑ National Register District (faire) <br />Certificate Of App Menled <br />teness: <br />❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />Address of Property for proposed work: UGJ" <br />y� r (Street Number—Street Name—City Zip) <br />Name of Property Owner(s):i�� 7 �,�5 L C) 41Ak C/A t^ L -L' C Phone 9: <br />Address of Property Owner(s): / lG L% tf /./f �j-r)lv'y Rv, .4-50, 141 A /:-,,w,/Z) A <br />(Street Number—Street Name—City—Zip) <br />Name of Contractor(s): 74, RE br- 70? AA JA)PT) A T�'J�27 CIPL)NS Phone Ih <br />Contractor Company Name: <br />Address of Contractor Company: <br />'51 <br />(Street Number—Street Name—Cit)--Zip) <br />Current Use of Building: �' fE rAJX )L%/ <br />(Single Family Mitlti-Family—Commercial—Government Industrial—Vacant—etc.) <br />Type of Building Construction: /VM9 /t'jzo" rs <br />(lYood Frame Brick—Sion"feel—Concrete—Other) <br />Proposed Work: ❑ In -Kind _ ❑ Landscape ❑ New ❑ Replacement (not in-kind) Demolition <br />(more than one box may be checked) <br />Description o f P ro p o s e d Wo rk: -h—E-%_V)G/L17'1 UW (//= 1AM135 r <br />7MGLt=�btt�°`)SO�rifi(hr�n )tii, Dov, <br />Owner e-mail: <br />, and/or Contractor e-mail: <br />X //� /It / ��'GA>` l and/or X <br />Signature d btivni'r Signature of Contractor <br />By signing this application I agree to abide by all local regulations related to project and to obtain a Building Department Permit, Vapplicable. <br />—APPLICATION' REQUIREMENTS ARE LISTED ON RE«RSE SIDE— <br />