Laserfiche WebLink
Application <br />- FOR - <br />Certi ficate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />Mailing Address: County -City Building, South Bend, Indiana 46601 <br />Phone: 574-235-9798 - Fax: 574235-9578 • Email: SBSJCHPCQm.st joseph.in.us <br />Website: www.s"hcounbiridiana.com/sichp/index.htn-d <br />A Certified Local Government <br />OFFICE USE ONLY »»> DO NOT COMPLETE ANY ENTRIES CONTAINED IIV THIS BOX »»y> OFFICE USE ONLY <br />Date Received i J t `4 Application Number 1.O 1 ` - 3 [ <br />Past Reviews: i] YES (Date of Last Reoiem) <br />Staff Approval authorized by: <br />Historic Commission Review Date: <br />M • <br />Title: <br />[] Local Landmark Ua Local Historic District (Name) <br />[� National Landmark ❑ National Register District (Name) <br />Certificate of Appropriateness: <br />I] Denied n Tabled E] Sent To Committee [] Approved and Issued <br />Address of Property for proposed <br />DATE <br />Name of Property Owner(s): (Please Print) <br />Address of Property Owner(s): 2a <br />Contractor(s) Name: f e T L A .,N Een cj r a - <br />Contract Company Name: 131740JOI 14-411 <br />4lJ <br />Contractor Address: t �� ( t s +o !r <br />City: Phone: <br />Current Use of <br />(Si4le Fanjtily Multi Amily - Commercial - Government - Industrial - Vacant - etc.) <br />Type of Building Construction: In./o,")��M <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: [I In-kind [] Landscape [:4 C ew E] Replacement (not in-kind) Ej Demolition <br />(more Man one box mmj be checked) <br />Description of Proposed Work: +� i S I -t�G� Cl,f-'r C k. I Ix l 'KA:_1Q <br />0 <br />0 <br />Owner/Contractor.. Fax: e-mail_ � h�3 " • <br />(This office will Co ul with only one des ) �— <br />and/or <br />ignature of Owner Signature of Contractor <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />