Laserfiche WebLink
I <br />U <br />r1 <br />L_J <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/govemment/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 Patio Service Elicia Feasel, Historic Preservation <br />Administrator <br />APPLICATION FOR A - CERTIFICATE OF APPROPRIATENESS <br />OFFICE USE ONLY—S DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX— ­—OFFICE USE ONLY <br />Date Received: , ` Application Number: <br />1191(; W2 <br />Past Reviews: YES (Date of Last Review) ❑ NO <br />Staff Approval authorized by: <br />Historic Preservation Commission Review Date: <br />qLocal Landmark <br />❑ National Landmark <br />Certificate OfAppropriateness: <br />Denied ❑ Tabled <br />Title: <br />1117 <br />❑ Local Historic District (Name) <br />❑ National Register District (Name) <br />❑ Sent To Committee ❑ Approved and issued: <br />Address of Property for proposed work: L_V(ZX0(`7 C./ I " 1 tL-et o-1 i V X -S . Q -V/ . l.,Sta <br />(Street Number—Street Name—City—Zip) <br />Name of Property Owner(s): l5zl e hrZ l' Phone M J ,cq <br />Address of Property Owner(s):vy� • O.0- I _-EKJ 1-6 . b2 <br />(Street Number—Street Name—City—Zip) <br />_VZName of Contractor(s): O Phone #: <br />Contractor Company Name: <br />Address of Contractor Company: <br />Current Use of Building: <br />Type of Building Construction: <br />Proposed Work: 11 In -Kind <br />(more than one box may be checked) <br />Description of Proposed Work: <br />(Street Number= -Street Name—City--Zip) <br />t&A��CIA <br />Family—Mtdti-Family—Commercial—Government Industrial—Vacant—etc.) <br />od Frame Brick—Stone---Steel—Concrete—Other) <br />❑ Landscape ❑ New ❑ Replacement (not in-kind) Demolition <br />• Owner e-mail: 47eCQl�o and//or Contractor e-mail: <br />X � (l.t' �C��S�. �. L-'-' U 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 />