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SOUTH 8 <br />• �o� X40 <br />F 7; <br />r, <br />PtACa <br />1865 <br />• <br />HISTORIC PRESERVATION COMMISSION <br />OF SOUTH BEND AND ST. JOSEPH COUNTY <br />County—City Building, South Bend, IN 46601 <br />http://www.stj osephcountyindiana.com/438/Historic-Preservation-Commission <br />Phone: 574/235.9798 Fax: 574/235.9578 <br />Email: SBSJCHPC@sjcindiana.com <br />Timothy S. Musczinski, President A Certified Local Government of the National Park Service Elicia Feasel, Executive Director <br />APPLICATION FOR A — CERTIFICATE OF APPROPRIATENESS <br />OFFICE USE ONLY»» G»DO NOT COMPLETE ANY ENTRIES CONTAINED IN TFIIS BOX«««OFFICE USE ONLY <br />Date Received: 3 /2 Z U (ZJ Application Number: 20i% — 0$0 -2 - <br />Past <br />$0'zPast Reviews: ❑ YES (Date of Last Review) ❑ NO <br />Staff Approval authorized by: <br />Title: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark Q Local Historic District (Name) L AST Wt}�yt <br />❑ National Landmark ❑ National Register District (Nmne) <br />Certificate Of App ro riateness: <br />Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />Address of Property for proposed work: I/ Z S t- W A vJ NV-- 6 1 - <br />(Street Number—Street Name—City—Zip) <br />Name of Property Owner(s): I7A01 E L -i- F E- 1'� 413ETF/ COLLJ eeotd Phone #: <br />ni-i uNb/ti! `l(vi <br />331 St/39 <br />3'31 -`l Sia <br />Address of Property Owner(s): i2 �' E w 6,jty E STrn lEeT Sov7'M 01:Np t PJ Hfo(v1S <br />(Street Number --Street Name—City—Zip) <br />Name of Contractor(s): Lou C-' S M t 5 PIAW A vtA 02-00 Phone #: � � f 7 � (o -IS — S !'18 <br />Contractor Company Name: <br />L.O W r `5 n � ZOO <br />Address of Contractor Company: <br />+-ltcf00 (rfzAPr 26&0 M 1 SN4-w4vr&1 t�y-14(o59S <br />(Street Number—Street Name—City—Zip) <br />Current Use of Building: Sc n;�) L'-' 1^c—" t, <br />(Single Family—Multi Family—Commercial—Government Industrial—Vacant—etc.) <br />Type of Building Construction: L inAr,J 2.�LpU.cc..M• t <br />(Wood Frame Brick--Stone—Steel—Concrete—Other) <br />Proposed Work: ❑In -Kind ❑ Landscape ❑ New ® Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) <br />Owner ail: t A �I eitt aid RL� . P./J�✓ and/or Contractor e-mail: <br />Si afore of Owner <br />and/or X <br />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 />is— <br />