Laserfiche WebLink
JUN 21 2018 lniq_ <br />IZ,ee. t+ 1113['11--n� Z cx <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 Path Service Elicia Feasel, Historic Preservation <br />Administrator <br />APPLICATION FOR A — CERTIFICATE OF APPROPRIATENESS <br />OFFICE USE ONLiS»»>DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY <br />Date Received: 1 7-c I Application Number: G'-�' ( 00 — o(, 7 j C <br />Past Reviews: YES (Date of Last Review) ❑ NO <br />Staff Approval authorized by: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark <br />❑ National Landmark <br />Title: <br />Local Historic District (Name) 1=�cXwavt-* <br />❑ National Register District (Name) <br />Certificate Of Appropriateness: <br />Denied ❑ Tabled Dent To Committee ❑ Approved and issued: <br />Address of Property for proposed work:`` j <br />(Street Number—Street Name—City—Zip) <br />Name of Property Owner(s): C.1aa'n P 06(Au'("( Phone #: 6-14 - M3 b 13 <br />Address of Property Owner(s): <br />(Street Number—Street Name—City—Zip) �• 2 <br />Name of Contractor(s): � � jai ii(� ' �W,Kk S Phone #: <br />Contractor Company Name: <br />Address of Contractor Company: <br />Current Use of Building: <br />(Street <br />Type of Building Construction: _ L -)Al VV <br />(Wood Frame—Brick—Stone—Steel--Concrete—Other) <br />Proposed Work: (more than one ❑ Landscape ElNewReplacement (not in-kind) ❑ Demolition <br />box may be checked) <br />Description of Proposed Work:. Eci k,,o-0 m-Ae a U `S Vj ata Q_b\ `(1(A <br />Owner e-mail: and/or Contractor a -mail: „ 4W QU w LV &, ft <br />X and/or X <br />Signature of Ownerr' 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 />• <br />