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is <br />JUN 212018 IM <br />R-eE. N- 1t-33'PCb J%c)P. <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/govemmenttdepartment/community-investment <br />Phone: 574/235.9371 Fax: 574/235.9021 <br />Email: hpcsbsjc@southbendin.gov <br />Timothy S. Kiusczinski, President A Certified Local Government of the National Patio Service Elicia Feasel, Historic Preservation <br />Administrator <br />APPLICATION FOR A — CERTIFICATE OF APPROPRIATENESS <br />OFFICE USE ONLYS»»>DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS_BOX«««OFFICE USE ONLY <br />Date Received: (v 2_ 0t � Application Number: 10 (10 — 0G, 2-1 C <br />Past Reviews: M 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 Ofppro riateness: <br />Denied ❑ Tabled <br />Address of Property for proposed work: <br />Title: <br />Local Historic District (Name) <br />❑ National Register District (Name) <br />❑ Sent To Committee ❑ Approved and issued: <br />q b [PC) <br />ff�� <br />(Street Number—Street Name—City—Zip) <br />Name of Property Owner(s): o'� (� bn t 0eJ_Ae k,^Q ( Phone #: 5-74 - 03 La 133 <br />Address of Property Owner(s): <br />(Street Number—Street Name--City—Zip) <br />Name of Contractor(s): (xaC� eti ��,{� �u� rn�c�5k�`t ES Phone #: <br />Contractor Company Name: <br />Address of Contractor Company: <br />Current Use of Building: <br />(Street <br />Type of Building Construction: <br />Proposed Work: (more than one <br />box may be checked) <br />Description of Proposed Work: <br />(Wood <br />❑ Landscape ❑ New M Replacement (not in-kind) ❑ Demolition <br />.Owner e-mail: and/or Contractor a-mail:y����x� <br />X and/or X <br />Signature of Owner/ ' Signature of Contractor <br />1 <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 />