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• <br />is <br />• <br />JUL A 2 2018 {MA <br />-Re r, Wo. '7 1,5 705 <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/goveini-nent/depaitment/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 ONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS((BOOX«««OFFICE USE ONLY <br />Date Received: �� Application Number: Q01o_— V 1 01 <br />Past Reviews: YES (Date of Last Review) 'ppLAb�1 U �t-)5 p 1-1 NO <br />Staff Approval authorized by: <br />Historic Preservation Commission Review Date: C) {k_q 1� . 2 O 3 <br />Local Landmark ❑ Local Historic District (Name) <br />❑ National Landmark ❑ National Register District (Name) <br />Title: <br />Certificate Of Appro rlateness: <br />Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />Address of Property for proposed work: <br />Name of Property Owner(s): <br />Address of Property Owner(s) <br />(Street Number=—Street <br />Name of Contractor(s): A , C1 yPhone #: <br />Contractor Company Name: <br />Address of Contractor Company: Z <br />Current Use of Building: o -kcp_ <br />(Single <br />Type of Building Construction: <br />Proposed Work: In -Kind <br />(more than one box may be checked) <br />Description of Proposed Work: <br />(Street <br />Vacant—etc.) <br />Wood Frame—Bi-ick—Stone--Steel—Concrete—011ier) <br />Landscape [TNew ❑ Replacement (not in-kind) ❑ Demolition <br />X <br />Signature of Contractor <br />this application 1 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 />