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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/govemment/department/community -investment <br />Phone : 574 /235.9371 Fax: 574/235 .9021 <br />Email : hpcsbsjc@southbendin .gov <br />Mich ele Gel fman , Pre si dent A Certified Local Government of the National Park Seivice 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 Rece ived: -------Application Number: <br />Past Reviews: D YES (Date of Last Review) -----------NO <br />Staff Approval authorized by: Title: ------------------------------- <br />Historic Preservation Commission Review Date: __________________________ _ <br />D Local Landmark <br />D National Landmark <br />D Local Historic District (Name) ______________ _ <br />D National Register District (Name) _____________ _ <br />Certificate Of App ~iateness: <br />LJ Denied Tabled D Sent To Committee D Approved and issued: _______ _ <br />Address of Property for proposed work: . '$di_: W.. falf,:At':,'OV"-., Su v rk f.?-e ""2A <br />(Street Number-Street Na'me-City-Zip) <br />Y-t6o/ <br />Name of Property Owner(s): _T)_O_Vl_c::;\,_{_c,( __ B~r.~c)~W_-e_, _______ Phone#: :/-l? -L/ '-lo -roo (, <br />1~17..-E . Wc-yV\-e_ ~l-.1 S~ 15&vl Trv ,, '-16~tf_. <br />(Street Number-Street Name-City-Zip) <br />Address of Property Owner(s): <br />Name of Contractor(s): ______________________ Phone#: ________ _ <br />Contractor Company Name : --------------------------- <br />Address of Contractor Company: <br />------~--:---;-;-----;----;:;:---:-:-;----=::-----=-:--,----------(Street Number-Street Name-City-Zip) <br />Current Use ofBuilding: M U / .J-.: f=C,....yv\ ,-{ V <br />-----;(S;;;,~.n-:-g/,--_e-;F::;-a-m-:il-;-y----;M;--;u-;l~ti-J.Ji.~a-m-:il-;-y---:C::;-o-m-m-e-r-c1:--.a-;-l -G-:::--ov-e-rn-m-en-1---=In:--d-:-u-s-tr-ia....,l _V:_a-ca_n_t_e_tc_.) ___ _ <br />Type of Building Construction: W o vol ,= ,r ""-W'-<... ) S' f-v c. c.... D <br />-~-~~~-:~~o:--:o-;d:-;F:;---r-am-e---l--;;B-;ri:=--ck;---S~t:--o""ne.....:-S~t=--e-el:--C:::-o-n-c-re-te---=o:--th:--e-r),---------- <br />Proposed Work: (more than one <br />box may be checked) D Landscape D New Replacement (not in -kind) D Demolit ion <br />Description of Proposed Work: f2.. <. pc..> S: t1"· -<...vt :::9:-v.> I--,~ f,,1_;rY1 l-?0 ,,-J,,.__ . <br />(S'Le: 6L H-....ow cLv co'v=vd) . <br />Ow~mail : Jovt ,b-row--<-/{?JJ,1,te.,·/, Cc>~and/or Contractor e-mail: _____________ _ <br />X Jozb f'>cff7y _, and/or X <br />Signature of Owner Sign.:-:a::t--::u::-re:--o~f:--;C~o:--n-:-t-ra-c-:-to_r ___________ _ <br />By signing this appli cation I agree to abide by all local re gul atio ns related to proje ct and to obt ain a Buil ding De partme nt Permit , if appl ica ble .