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Michele Gelfman, President <br />Nov 0 2 2018 M4 <br />7(0_6-79t TaP_PL) <br />HISTORIC PRESERVATION COMMISSION <br />OF SOUTH BEND AND ST. JOSEPH COUNTY <br />County—City Building, South Bend, IN 46601 <br />http://www.soutlibeild in.gov/government/department/community-investment <br />Phone: 574/235.9371 Fax: 574/235.9021 <br />Email: hpcsbsjc@southbendin.gov <br />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 BOX«««OFFICE USE ONLY <br />Date Received: x'41 i,2 Application Number: <br />Past Reviews: ❑ YES (Date of Last Revie)v) ❑ NO <br />Staff Approval authorized by: <br />Historic Preservation Commission Review Date: <br />Local Landmark <br />❑ National Landmark <br />Certificate Of Appropriateness: <br />Denied <br />Title: <br />❑ Local Historic District (Name) _ <br />❑ National Register District (Name) <br />❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />Address of Property for proposed work: <br />1032 East Wayne Street <br />(Street Nztmber—Street Name—City—Zip) <br />Name of Property Owner(s): Emberton Development Phone #: 574-286-7119 <br />Address of Property Owner(s): 26230 Twin Lakes Trail <br />(Street Ntznzbei —Street Naine—City—Zip) <br />Name of Contractor(s): Justin Leatherman <br />Contractor Company Name: Leatherman Supply <br />Phone #: 574-536-1159 <br />Address of Contractor Company: 2423 Peddlers Village Rd, Goshen, IN 46528 <br />(Street Nutnbet=Street Naine—City—Zip) <br />Current Use of Building: MU - Mixed use <br />(Single Family—Adttlti-Famil)---Coizvnercial—Government—Industrial—Natant—etc.) <br />Type of Building Construction: Brick / Wood <br />(!food Frame—Bricic—Stone—Steet—Concrete—Other) <br />Proposed Work: (more than one ❑ Landscape ❑ New ❑ Replacement (not in-kind) ❑ Demolition <br />box may be checked) <br />Description of Proposed Work: Replace some windows <br />Ownere-mail: b.emberton@outiogk.com and/or Contractore-mail: Justin@leathermansupply.com <br />X i and/or X <br />Signatur of O >er 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 />