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DECO 3 2Q18 Aec. 76 57-56 TAQVP <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/departmcnt/community-investment <br />Phone: 574/235.9371 Fax: 574/235.9021 <br />Email: hpcsbsjc@southbendin.gov <br />Timothy S. Klusczinski, President 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 ONL >—>DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX—<—OFFICE USE ONLY <br />Date Received: 112- 2 o i $ <br />Application Number: 2018 _ 1204 <br />Past Reviews: © YES (Date ufLast Review) 10/15/2018 ❑ NO <br />Staff Approval authorized by: <br />Titre: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark <br />❑ Local Historic District (Name) <br />❑ National Landmark <br />❑ National Register District (Name) <br />Certificate Of App ro riateness: <br />E Denied ❑ Tabled <br />❑ Sent To Committee ❑ Approved and issued: <br />Address of Property for proposed work: R f 6fj,t%'� �S /" %'ls Cor(' ?rYr=�7 1A) <br />(Street Number—Street Narne—City—Zip) <br />Name of Property Owner(s):Phone #: <br />Address of Property Owner(s): v�5 to / ��//�JGd 47'�AbWA-! 345V,e /b(/ yf /lam <br />(Street Number—Street Name—City—Zip) <br />Name of Contractor(s): <br />Phone #: <br />Contractor Company Name: <br />r, <br />Address of Contractor Company: <br />(Street Number—Street Name—City—Zip) <br />Current Use of Building: e G <br />(Single Fami <br />Vacant—etc.) <br />Type of Building Construction: r Gl` �/ , N 1-i 0144;5 000 lCeAA' G2 }A tJ yT <br />(Wood Fra)?ce---Eric,(—S1©ne—Steel--Concrete---011ier) <br />Proposed Work: an -Kind ❑ Landscape ❑ New ❑ Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) <br />Owner a -mail; t V 1 yfs f v a) 69A&A5T, ttje'r nd/or Contractor e-mail: RiPG� CgM/l7� , Cyh( <br />X 0 /--, and/or X <br />Signature of Owner 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, if applicable. <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />