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JUN 212018 /7/7,q , <br />R,ee. t- 11131"M � ? <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/goven ment/deparlmentleommunity-investment <br />Phone: 574/235.9371 Fax: 574/235.9021 <br />Email: hpcsbsjc@southbeadin.gov <br />Timothy S. Klusezinski, President A Certified Local Government of the National Park Service <br />Elieia 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: t'7,rs 18 Application Number: _20(y — (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 />Certificate Of Appropriateness: <br />Denied ❑ Tabled <br />Address of Property for proposed work: <br />Title: <br />EfLocai Historic District (Name) _ 1�14__e4-1r <br />❑ National Register District (Name) <br />❑ Sent To Committee ❑ Approved and issued: <br />� LP POD <br />cam, (Street Number -Street Name—City-Zip) <br />wb. <br />Name of Property Owner(s): n �� e� Q o c Phone #:� <br />Address of Property Owner(s): <br />(Street Number --Street Name--City—Zip) ; t <br />Name of Contractor(s): � �A `ti11�h A&U5 1,1 1A6n es Phone #: <br />Contractor Company Name: <br />Address of Contractor Company: <br />Current Use of Building: <br />(Street <br />Type of Building Construction: <br />Proposed Work: (more than one ❑ Landscape <br />box may be checked) <br />Description of Proposed Work: <br />Frame—Brick--Stone—Steel—Concrete—Other) <br />❑ New '12\1 Replacement (not in-kind) <br />W <br />❑ Demolition <br />Owner e-mail: and/or Contractor e-mail: <br />X 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 />