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Michele Gelfman, President <br />SEP 2 8 2018 fn <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/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 ONLIS»»>DO NOT COMPLETE ANY ENTRIES CONTAWED W THIS BOX«««OFFICE USE ONLY <br />Date Received: q _.; 17.e 18 Application Number: / 1 — G9 2 $ <br />Past Reviews: YES (Date of Last Review) a V, {.- ❑ NO <br />Staff Approval authorized by: <br />Title: <br />Historic Preservation Commission Review Date: o k 06 <br />Local Landmark Local Historic District (Name) <br />❑ National Landmark <br />Certificate Of Appropriateness: <br />11 Denied ❑ Tabled <br />❑ National Register District (Name) <br />❑ Sent To Committee ❑ Approved and issued: <br />Address of Property for proposed work: 3 2- 1 �Pc� 1�'I r� �� �I-( 1 ; S a C 1361 4 D <br />(Street Number—Street Name—City— i!p) <br />• <br />Name of Property Owner(s): H0 U-1 TNtL- Phone #: mg (? �- O <br />Address of Property Owner(s): <br />W�Si�lr-�y[�o-IJ S <br />(Street Number—Street <br />�)CGPA D <br />Name of Contractor(s): Ti>y, Phone #: <br />Contractor Company Name: <br />Address of Contractor Company: <br />Current Use of Building: <br />(Street Number—Street Name—City—Zip) <br />Slig�TLG _eAMiL .- <br />(Single Family--Multi-Family—Commercial—Government—Industrial—Vacant—etc.) <br />Type of Building Construction: aro brl vk-> <br />(Wood Frame—Brick-Stone—Steel—Concrete—Other) <br />Proposed Work: (more than one <br />box may be checked) 11Landscape New M Replacement (not in-kind) ❑ Demolition <br />Description of Proposed Work: VA, tAAAV n LU-i•1� WtyAws -• <br />�loV,3�11. L Nc1.c�,n U -I - <br />Owner e-mail: and/or Contractor e-mail: • <br />X and/or X <br />Sig re f Ow Signature of Contractor <br />(t-4 Ir y signing this application I agree to abide by all local regulations related to project and to obtain a Building Department Permit, if applicable. <br />♦ 1M"T lr� ♦ TT/ AT 1TT/1TTTT , TRT ATT[' A "W T TVA WTI AAT T1TTTT'1nVT.T C+T7 W <br />