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• <br />• <br />• <br />M Re-efi ma9SS3 L`aplp <br />MAY 2 2 2018 <br />HISTORIC PRESERVATION COMMISSION <br />OF SOUTH BEND AND ST. JOSEPH COUNTY <br />County --City Building, South Bend, 1N 46601 <br />http://www.southbendin.gov/government/department/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 Padc 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: 12-TYttat,l 1 q <br />Past Reviews: ❑ YES (Date of Last Review <br />Staff Approval authorized by: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark <br />❑ National Landmark <br />Certificate Of App ro riateness: <br />Denied ❑ Tabled <br />Application Number:( — 6`530 A <br />) ❑ NO <br />Title: <br />Local Historic District (Name) /1! '_.', Pe""'Lc <br />National Register District (Name) � <br />❑ Sent To Committee ❑ Approved and issued: <br />Address of Property for proposed work: (0 05 Rex S-Frt e+- So o i�, Bend I n/ V(0 (0 1(v <br />(Street Number --Street Name—City—Zip) <br />Name of Property Owner(s): <br />.Soon 1'7owAo <br />Phone #: 6 -74 -SE -9 • (o 3 Y!p <br />Address of Property Owner(s): �S �{ Q Fot►t S + ASV G 5 VJt'h S C4% <br />(Street Number—Street Name—City—Zip) <br />Name of Contractor(s): FQ a e e e t_ a e+ A Co 'V% Y o n 1 Phone #: 514 " 2 S 9 -Lt 4a,'Z <br />Contractor Company Name: <br />Address of Contractor Company: �j'�' -9as+ Mss h a.w ova Ave. SO ai► 6" ;N y(o& l5 <br />(Street Number—Street Name—City—Zip) <br />Current Use of Building: <br />Ingle Famil Multi-Family—Commercial—Government—Industrial—Vacant--etc.) <br />Type of Building Construction: <br />Proposed Work: ❑ In -Kind ❑ Landscape <br />(more than one box may be checked) <br />Description of Proposed Work: .SCP_ at Q cAe-A <br />New ❑ Replacement (not in-kind) ❑ Demolition <br />Owner e-mail: t o w� b D W Y►S a -L Q ma 1 l• a nd/or Contractor e-mail: <br />X p �,> 1�---� and/or X <br />Signat 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 />