Laserfiche WebLink
Application <br />- FOR - <br />Certificate of Appropriateness <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette 131vd.. South Bend, IN 46601 <br />http:/hNi4,%v.stjosepheountyind iaiia.coin/departments/SJC I IP/index.htm <br />p: 574-335-9798 f: 574-235-9578 e: S13SJCHPC@eo,st-joseph.in.us <br />OFFICE USE ONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX<<«OFFICE USE ONLY <br />Date Received Q p�` I Application Number: L yml — 2- <br />Past Reviews: ❑ YES (Date of LastReiew) ❑ NO <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 />Title: <br />❑ Local historic District (.Mame) <br />❑ National Register District (.vome) <br />❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) t 1 / ) { c I- / �j ,i /'I) <br />Address of Property for proposed work: j; !I / 7 IA16-k //i r" ` `, i7 (� T `�t gevi6i � I �` -141 l/ <br />(.Street ArAiber—Street Code) <br />Name of PropertyOwner(s):�o;(`/,sj1 `JuUt;(ll'f.��l�.6t��'�ii►��K,�h)✓tPhone#; q1J, '�0l/' y��V/ <br />Address of Property Owner(s): q17 <br />(Street Ni mber• • Street Nanie—Qv­ Zip Code) <br />Name of Contractor(s): <br />Contractor Company Name: C /11 Ci rn <br />Address of Contractor Company: <br />Picone #: <br />s^.AJC Z- 1 <br />(Sb•eet Nianhei•— Street A'ame—Citj•-...Lip Code) <br />Current Use of Building: Avq /E�<i• vYt i�/ li1/vrk /,v <br />(Single Faniil} Mrtlti-Fnniil}/Cwiiniercial—Gorernmeni- I►rdustrial `�acarn -etc.) <br />Type of Building Construction: <br />(IYood Frauie •Brick—Slone—Steel---Concrete—Othet) <br />Proposed Work: ❑ In -Kind � Landscape ❑New ❑ Replacement (not in-kind) eM Demolition <br />(more than one box mcn, be checked) <br />i <br />Description of Proposed Work; �' ?)►/� ' C. Gc $' q.l'ro <br />E'G'2/<r.r•-1 Y1�' 4/1 �»rs��:'% it Ke,,4ac4 ✓ S1,,>°ia�<�.SS <br />Owner/Contractor Fax #: <br />X/� <br />Sig nat'ure of caner <br />e-mail: <br />and/or X <br />Signature of Contractor <br />