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• <br />Is <br />OCT -1 2019 ` A' <br />fjl e -t* 7Io§V� <br />HISTORIC PRESERVATION COMMISSION <br />OF SOUTH BEND AND ST. JOSEPH COUNTY <br />County—City Building, South Bend; IN 46601 <br />http://www.southbend in.gov/government/department/coin m unity -investment <br />Phone: 574/235.9371 Fax: 574/235.9021 <br />Email: hpcsbsjc@southbendin.gov <br />Michele Gelfman, President A Certified Local Government of the National Pmk Service Elicia Feasel, Historic Preservation <br />Administrator <br />APPLICATION FOR A - CERTIFICATE OF APPROPRIATENESS <br />OFFICE USE ONL >> DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOY«««OFFICE USE ONLY <br />�1 <br />Date Received: d t�f Z Application Number: — 160 I0 <br />Past Reviews: YES (Date of Last Review) ❑ NO <br />Staff Approval authorized by: <br />Title: <br />Historic Preservation Commission Review Date: 0 GV E 1 3-() 8— <br />IffLocal Landmark 19 Local Historic District (Name) , (1 t- <br />1:1 -- <br />❑ National Landmark <br />Certificate OfApp ro riateness: <br />f Denied ❑ Tabled <br />❑ National Register District (Name) <br />❑ Sent To Committee ❑ Approved and issued: <br />Address of Property for proposed work: PANt Divi%- Via-, A '1ENti , 1N kbb I h <br />(Street Number --Street Name—City—Zip) <br />Name of Property Owner(s): JOHN 40 ' fVLONlfq 5\IfwrL'A l Pbone #: 5"1Lj -7,33-731 1 <br />Address of PropertyOwner(s): 72-0 pmi_ ,. 50ttTH 1WE14i) it/ Ab It <br />(Street Ntanber—.Street Name—City—Zip) <br />Name of Contractor(s): ti !A'7-,4z-V1F_t7 (` CVC -ML f"jC—Ow') Phone #: <br />Contractor Company Name: <br />Address of Contractor Company: <br />(Street Number—Streel Name—City—Zip) <br />Current Use of Building: $IyVi4G _FMW1'( <br />(Single Familn—;l-lulti-Fcnniln—Commercial—Government—Industrial—locant—etc.) <br />Type of Building Construction: V'Vt q ei WC- <br />(6Vood Fi•ante—Brick—Stone—Steel—Cancrele—Othei) <br />Proposed Work: (more than one LJ Landscape ❑ <br />box may be checked) New L-16Replacement (not in-kind) ❑Demolition <br />Description of Proposed Work: <br />Owner a -mail: Aj jC.falS%yxa( qy._\ Q &MAt(,_ Cc n1 and/or Contractor e-mail: <br />X and/or a <br />Signature of Owner Signature of Contractor <br />By siAiinL isapplication I agree to abide by alt local regulations relaled to project and to obtain a Building Department Permit. if applicable. <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />