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HISTORIC PRESERVATION COMNIISSION <br />t� 1di OF.S;OUTH BENI) AND ST. JOSEPH COUNTY, <br />rr,ce a' County-City Building, South Bend, IN 46601 <br />- <br />\ a / http://www southbendin.gov/goveinmeiiVdep"ent/community-investment' <br />Phone: 574/235.9371 Fax: 574/235.4021 <br />Email: hpcsbsjc@southbendin.gov <br />Timothv S. Klusczinslti; President A Certified Local Government of the National Park Service Elicia Feasel, Historic Preservation <br />Admintstrato; <br />APPLICATIONFOR A — CERTIFICATE OF APPROPRIATENESS <br />OFFICE USE ONLY>1--DO NQ <br />LT COMPLETE ANY ENTRIES CONTAINED" INTHiS.BOC««<DFFICE USE ONLY <br />Date Received: Z 'l Z c�,l. Application Number: 210 --03 09 <br />Past Reviews: ❑ YES (Date of Last Review) ❑ NO <br />Staff Approval; authorized by: Title: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark ❑Local Historic District'(Nanre) <br />❑ National Landmark El Register District (Name) <br />Certificate Of Appro riDenTabled, Sent To Committee } . Denied El❑ ' ❑Approved and issued: <br />Address sof Propert for proposed work• p1 t <br />' (StreetNumber—,Street Name—City—Zip) <br />Name of Property Owner(s): C�tfr�/'--LCf 3 �- t T-T V Phone #:,S7 Z3,Z S7 V 6 <br />Address of Property Owner(s): , ( ' l U Ld�1 �! c � . Lit � <br />( arrie—City �Zi ) <br />Street Number <br />/N p f / <br />Name of Contractors) 1, C ('� /f's c_I.' %j` 1 Phone #: , 7 K-� 1' <br />Contractor ComQanv Name:. 1 J kfi~ cC .,,+ <br />Address of Contractor 'ompanv. ! •( L l '' �J(y t1 &L : fj, %11 1�U,( 6 % <br />(Street Number—Street Name-1-City—Zip) <br />Current Use of Building; <br />(,ingle Family-Multi-Fami, ommercial—,Government—Industrial—Vacant-etc,)`' <br />Type of Building Construction: lit M t rj✓- a K' d / J <br />(Wood Frame-,7Bric —.Stone Steel--�Concrete—Other) <br />Q7 <br />Proposed Work: 'I l Ia-Kind ❑ Landscape El-New'' L Replacement (not in-kind) ❑ Demolition <br />/more than one, box may be checked) <br />]Description of Proposed Work: � �PA II P (1 GL'� (,? 6 <br />0-T f, <br />:. <br />.Owner it-mail:1 . 0/4 0P _ and/or Coni <br />>xractor email. <br />X _ and/or X e— <br />, <br />Signature,of Owner �'�: Signature of Contractor <br />amine finis apuiicadon I avree 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 />