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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 />Michele Gelfman, President A Certified Local Government of the National Parle Service Elicia Feasel, Historic Preservation <br />Administrator APPLICATION FOR A-CERTIFICATE OF APPROPRIATENESS <br />OFFICE USE ONLY>>»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN TIDS BOX««<<OFFICE USE ONLY <br />Date Received: --------Ap plication Number: <br />Past Reviews: D YES (Date of Last Review) -----------□ NO <br />Staff Approval authorized by: ______________________ Title: _________ _ <br />Historic Preservation Commission Review Date: -----------------------------□Local Landmark D Local Historic District (Name) _______________ _D National Landmark D National Register District (Name) _____________ _ <br />Certificate Of App�riateness: LJ Denied □ Tabled D Sent To Committee D Approved and issued: _______ _ <br />Address of Property for proposed work: 1515 E. wa <br />Address of Property Owner(s): <br />Contractor Company Name: Ml W ±tvJtU)(� <br />Address ofContract orCompany: �802./ st.-tq(Js� Ahrrone..e.7 m 4lo55D(Stre Num�e,:�r'ee?'tJ,�City-Zip) J <br />Current Use of Building: -------""'---'----"�c.;..._---a:�::......;:.....:.....;;.;('-'l'----A------------------- <br />Type of Building Construction: <br />Proposed Work: (more than one <br />box may be checked) <br />··al-Government-Industrial-Vacant-etc.) <br />(Wood Frame-Brick-Stone-Steel-Concrete-Other) D Landscape �ew D Replacement (not in-kind) D Demolition <br />and/or Contractor e-mail:--------------- <br />and/or X --------------------Signature of Contractor