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• <br />App cation <br />-FOR - <br />Certificate of Appropriateness <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http://www.stjosepheountyindiana.com/departments/SJCHP/index.htm <br />P. J /'+-L-3J-7 /70 1: J r4-L3q)-7J /6 e: 6 <br />IIS <br />OFFICE USE ONLY>>"".DFJiY()'I'Ct7�tPLF:1'F:AK\'lNTRI[:SCOiVTrIlYr!)1N"1`II[5130 «««OFFICE USE ONLY <br />Date Received: <br />Past Reviews: ❑ YES (DnlenfLasiRevinv) <br />Staff Approval authorized by: <br />Historic Preservation Commission Review Dale: <br />❑ Local Landmark <br />11 National Landmark <br />Application Number: — <br />❑ Local Historic District (A4m,e) _ <br />❑ National Register District (limn <br />El NO <br />Title: <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) <br />Address of Property for proposed work: 237 N /+ti Gk;3,% . 4—LOO 15,,. 1> <br />• (Street Number- -Street Numre City—Zip Code) <br />Name of Property Owner(s): ictal Phone #: 31• % - f S - Y119 <br />Address of Property Owner(s): _ IOSo t 14f.0 �j G t Fa 5k C, $ TN y 6 a 3 & <br />(Street Number—Street Name—City—Zip Code) <br />Name of Contractor(s): * Am&" eo' ^y k-ra c 44 u r.s 2,4 K. ;�,Phone #: 1;79—S33 —514 t <br />Contractor Company Name: 4NC., <br />Address of Contractor Company: 237 ti Mt6t.:'k, :6- D S►_kL, -0 era TN q& 0� <br />/ (SA'eet Number— Street Aante--C y—T.ip Code) <br />Current Use of Building: <br />(Single Family—Ivtulii-Family—Commercial—Goverm?aefit—Industrial-f•'acant—etc.) <br />Type of Building Construction: tri C IC <br />(JT ood Frame—Bricic—Stoi?e—Steel—Conerete—Other) <br />Proposed Work: ❑ In -Kind ❑ Landscape New ❑ Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: rtl- e -.c i• Vic? -Ira 1-T -L e! 1-4 ,.c,,j <br />+4ng,eln: C,i 0.-_ ecetk LMlet) Ww d�/t il� !e.►+�- 1"`Ov..i.z f!I(,w��1 �yC� <br />dd ZCIV. <br />Owner/Contractor F x #: N Its e-mail: KR I N 6(p Cos,,• Co"34n,0'+J�l/ Co <br />X and/or X <br />Signature of Owner Signature of Contractor <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />