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MAR 1 3 2020 Ree,NO. 0115ti1D
<br />fXJ_vD
<br />HISTORIC PRESERVATION COMMISSION
<br />OF SOUTH BEND AND ST. JOSEPH COUNTY
<br />County-City Building, South Bend, IN 46601
<br />http://,vww.southbendin.gov/government/department/community-investment
<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 Palk Se1vice Elicia Feasel, Historic Preservation
<br />Administrator APPLICATION FOR A-CERTIFICATE OF APPROPRIATENESS
<br />TIIL BOX«««OFFICE USE ONLY
<br />Date Received: _______ _ Application Number:
<br />Past Reviews: D YES (Date of Last Review) ___________ _ □NO
<br />Staff Approval authorized by: _______________________ Title:
<br />Historic Preservation Commission Review Date: _____________________________ _ D Local Landmark D National Landmark
<br />D Local Historic District (Name) _______________ _ D National Register District (Name) ______________ _
<br />Certificate Of Appp!l!fiateness: LJ Denied □ Tabled D Sent To Committee □ Approved and issued: _______ _
<br />Address of Property for proposed work: _7_:J_q..___G:,---=;\\.......,.,,Q8"'7'2"'-,___,_6.£...L..C..:::cu_,,_y_,,,e,,,e____,.>:""---'-o-"v±�l.,.___,B=--=�"----"'ILL--L-/-"----6�6�(c..a6..__ __(Striat Number-Street Name-City-Zip)
<br />Name of Property Owner(s): _/4,___.__._/...,ch=-'-"',.et..,,e'-"1/c..,,/_ ..... U� ..... .f...,_�=-�-t="/----'I -«---'----------Phone#: Sts
<br />Address of Property Owner(s): _··_JL.1L)-_q_.___�=-=-kt�A,.::;,,,,.1R...,1'----'6�_,_("...::D=-y-.JL..:e�"'-----------------fl;1reel Number-Street Name-City-Zip)
<br />Name of Contractor(s): --�>�·�,e_,�\�J......_ __________________ Phone#: _________ _
<br />Contractor Company Name:
<br />Address of Contractor Company:-----------------------------------(Street Numbe,�Stree/ Name-City-Zip)
<br />Current Use of Building:
<br />(Single rc1111i�J1-Mu!ti-Family-Co111mercial-Go11ernmenf-l11d11s11·ial-Vacant-elc.)
<br />Type of Building Construction: __ w.::..::_o__::o=--J __ -t,--='-/'...:o._'---'fl,J..,,----4-' __..,,rt_,_..,,D"'-'-yVJ__,_,, ________________ _ (Wood Frame2Brick-.Stone 'tee/-oncrete-Ot!te,�
<br />Proposed Work: (more than one
<br />box may be checked) □Landscape DNew rneplacement (not in-kind) D Demolition
<br />Owner e-mail: M \-\e.,\o \, �\�r e J ""--�l and/or Contractor e-mail:
<br />X �£ ll,,L/\.....,1 and/or X ________ _ Signature of Owner Signature of Contractor
<br />By signing this application l agree to abide by all local regulations 1elated to project and to obtain a Building Depai1ment Permit, if applicable,
<br />-APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE-
<br />3/13/20 2020 0406
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