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LG Ar(�� > <br />HISTORIC PRESERVATION COMMISSION <br />OF SOUTH BEND AND ST. JOSEPH COUNTYSEP O 4 2018 MA <br />County—City Building, South Bend, IN 46601 Re -7 667`7 <br />http://www.southbendin.gov/government/department/community-investlneiit -fl <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 Park Service Elicia 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: Application Number: 4 <br />Past Reviews: ❑ YES (Date of Last Review) NO <br />Staff Approval authorized by: <br />Historic Preservation Commission Review Date: )MV1 I_I L'" )s J <br />❑ Local Landmark ocal Historic District (Name) <br />❑ National Landmark National Register District (Name) <br />Certificate Of Appro riateness: <br />f Denied ❑ Tabled <br />Address of Property for proposed work: <br />Name of Property Owner(s): 'J <br />Address of Property Owner(s): <br />Title: <br />❑ Sent To Committee ❑ Approved and issued: <br />2 6 tL <br />(Street <br />06:4 651 &,✓l( <br />(Street <br />Name of Contractor(s): -5-at <br />Contractor Company Name: <br />Address of Contractor Company: <br />01 <br />#: h1W / `h -7 (o <br />6 <br />Phone #: <br />+- 0 <br />(Street Number—Street Name—City—Zip) <br />7 <br />Current Use of Building: 7 lid' <br />(Single Family—Multi-Family—Commercial—Government—Indush-tal—Vacant—etc.) <br />Type of Building Construction: <br />(Wood FtameB•ick—Stone—Steel—Concrete—Other) <br />Proposed Work: (more than one ❑ Landscape ❑ New ❑ Replacement (not in-kind) ❑ Demolition <br />box may be checked) <br />Description of Proposed Work: V6446A197 <br />Owner e-mail: and/or Contractor e-mail: cly,co <br />} $ <br />-: f • I <br />X and/or X <br />Signator 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 />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />