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HISTORIC PRESERVATION COMMISSION <br />OF SOUTH BE D AND ST. JOSEPH COUNTY <br />County-ity Building, South Bend, 46601 <br />http://www.southbendin.gov/govern111ent/departmenucommunity-invest111e11t <br />Phone: 574/235.9371 Fax: 574/235.9011 <br />Email: hpcsbsjc@southbendin.gov <br />pd 7f, <br /> <br />RGP O�Sl(t,/)7 <br />Michele Gelfman, President A Certified Local Government of the National Park Seivice Elicia Feasel, Historic Preservation <br />Administrator <br />APPLICATIO FOR A-CERTIFICATE OF APPROPRIATENESS <br />OFFICE USE ONLJ'>»»>DO NOT COMPLETE ANY ENTRlE CONT !NED IN THIS BOX«<«<OFFTCE USE ONLY <br />Date Received: _______ _ Application Number: <br />Past Reviews: DYEs (Date of Last Review) __________ _ □ NO <br />Staff Approval authorized by: ______________________ T itle: _________ _ <br />Historic Preservation Commission Review Date: ___________________________ _ D Local LandmarkD National Landmark <br />Certificate Of App�iatcness:LJ Denied □ Tabled <br />0 Local Historic District (Name) ______________ _D National Register District (Name) _____________ _ <br />0 Sent To Committee 0 Approved and issued: _______ _ <br />Address of Property for proposed work: /,5/ 7 l. WJt/Y AJE SCJLirt-t 6£-ND. IN L{I,' IS:(Street Number-Street ame ity-Zip) I <br />Name of PropertyOwner(s ): Vtc <f-Pi:(/1/l b£C0t i4=Phone#: S19-{'12-c2ocf <br />Address of Property Owner(s): __ 5::.......__,__A::>.....<..0.=.'-1......,.C_-:::--�--------------------------(Street Number-Street Name-City-Zip) <br />Name of Contractor(s ): ---'-A�.b__,J'-,4--'---A.J'-=-'L-=W=-=--....,_[<--=-O�O'---'P-L...C1 /L)----=-r.fob.L-----Phone #: '5] <{-(p 1 V -Y C:,) <br />Contractor Company Name: ----------------------------------­--­Address ofContractorCompany : 577(.a c>.....,R.A-Pc 'Rb 'M,tS,'1-/ 4w tt.k-4. )A) t:eos:rs (Street Number-Street Name-City--Zip) 1 <br />Current Use of Building: ---�-"-_;_/\J __ f._L_l3 __ h_1�nz __ 1_(___=._Y _____________________ _(Single F ami�v--A rut ti-F ami �v---Co m111ercial -Gove 1·11ment -!11d11strial-Vaca nt-etc.) <br />Type of Building Constru ction: __ tJ __ o_o_b __ F"';_"£_Pf_l'J1._e_-_____________________ __ <br />Proposed Work: (more than one box may be checked) <br />(Wood F1·ame-Bri ck-Sione--S1e e/-Co 11cre1e-Oth er) D Landscape O New O Replacement (not in-kind) D Demolition <br />Des�tion of Proposed Work: 7e:'"�,e,,. 'l) r!_: -t-RE .. RooF bT 1iec Srll/i./ (/.)CC�ooe w/ (1,AE+1V'::l Bee, (Ci Jl-; l:=J l). f\ (<C£':'.{ IITCTU,tj-( St-/111.l" (C5 <br />Owner e-mail: ______________ __ and/or Contractor e-mail: ______________ _ <br />x _________________ _ Signature of Owner and/or Y� �..::::::;._, __ """'.:.?,:::::._ ______ __ si�'actor <br />By signing this application I agrl!e to abide by all local regulations related to proj�ct and to obtain a Building, Department Pem1it, if applicable, <br />-APPLICATION REQUIREMENTS ARE LI STED ON REVERSE SIDE-