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C 7 <br />AUG 0 9 2018 MR �,a n C" <br />A er.. # 76.7� ! <br />HISTORIC PRESERVATION COMMISSION <br />OF SOUTH BEND AND ST. JOSEPH COUNTY <br />County—City Building, South Bend, IN 46601 <br />http://www.southbendin.gov/government/department/community-investment <br />Phone: 574/235.9371 Fax: 574/235.9021 <br />Email: hpesbsjc@southbendin.gov <br />A Certified Local Government of the National Park Service Elicia Feasel, Historic Preservation <br />Administrator <br />APPLICATION FOR A — CERTIFICATE OF APPROPRIATENESS <br />OFFICE USE ONLI'S»»>DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX<<zz<zOFFICE USE ONLY <br />Date Received: L' 2,0 k Application Number: 09041 A <br />Past Reviews: ❑ YES (Date of Last Review) ❑ NO <br />Staff Approval authorized by: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark <br />❑ National Landmark <br />Certificate Of App r o riateness: <br />u Denied ❑ Tabled <br />Title: <br />Local Historic District (Name) `wa4 =i"",t . S-_ <br />❑ National Register District (]Vane) <br />❑ Sent To Committee ❑ Approved and issued: <br />Address of Property for proposed work: 47 Lt <br />(Street <br />Name—City—Zip) <br />Name of Property Owner(s): 1 K�tt� f'i(► Y II r Co 11 1 %1�f'tr Phone #: <br />Address of Pronerty Owner(s): 131-0 r Wee eiiie_ s-;; bn`�d <br />Name—City—Zip) <br />itU&/s— <br />Name of Contractor(s): 4 Ir <br />�� / t 1( 16I NLai�1�'� Phone #: _7�'� � -J; �� <br />Contractor Company Name: �✓o ru4 fS eowilfvufivi / <br />Address of Contractor Company: �5 86b b lAr Pei �� l ��GGi.I �%� �t U, 3_�S— <br />(Street Number—Street Name—City—Zip) <br />Current Use of Building: <br />Type of Building Construction: <br />Proposed Work: (more than <br />box may be checked) <br />(Single Fi imily—Altdti-Family=Commercial=Government Indatstrial—Vacant—etc.) <br />VJ.r)0dA&,-,Ae / brtct- <br />(Wood Fi•ame—Brick—Stone—Steel—Concrete—Othei) <br />one ❑ Landscape ❑ New Replacement (not in-kind) ❑ Demolition <br />Description of Prolaosed Work: <br />shoe -1 6 t r o-r-r_tP 12 t -e <br />Owner e-mail: �QI Nji fi��', I • C Inn I nZ6 and/or Contractor e-mail: <br />X and/or X <br />Signature of Owner Signature of Cd <br />tractor <br />By signing this application I agree to abide by all local regulations related to project and to obtain a Building Department Permit, if applicable. <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />