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0 <br />Michele Gelfman, President <br />AUG 2 8 2018 /0 6q <br />e tit v. <br />76/57A7 T9QCx <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 ONLY— ­DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX— ­—OFFICE USE ONLY <br />Date Received: <br />Application Number: <br />Past Reviews: ❑ YES (Date of Last Review) <br />Staff Approval authorized by: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark <br />❑ National Landmark <br />❑ Local Historic District (Name) — <br />❑ National Register District (Name) <br />❑ NO <br />Title: <br />I Certificate Of Appropriateness: <br />Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />• Address of Property for proposed work: <br />g / /('Street Number treet Name—City—Zip <br />gName of Property Owner(s): i L L c T�(,�k 2" <br />• <br />Address of Property Owner(s): <br />Number—Street <br />Name of Contractor(s): <br />Contractor Company Name: <br />Address of Contractor Company: <br />Phone #: <br />(Street Number --Street Name—City--Zip) <br />Current Use of Building: <br />(Single Family—Multi-Family—Commercial—Government Industria[—Vacant—etc.) <br />Type of Building Construction: �CIQ 0/ <br />(Wood Frame—Brick—Stonn"teel—Concrete—Other) <br />Proposed Work: (more than one ❑ Landscape 11U New Replacement (not in-kind) ❑ Demolition <br />box may be checked) <br />Description of Proposed. Work: <br />0 <br />Owner e-mail: IAJ6 ` le d 0 &Y—, 3::4 and/or Contractor e-mail: <br />X and/or X <br />Signature of Owner Signature of Contractor <br />r <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 />