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�'la HISTORIC PRESERVATION CO1VI1�aSSION <br />� OF SOUTH BEND AND ST JOSEPH COUNTY <br />-. ,y � ��_ u County Ctty Bmlatng. Souih Bcnd. SN 46601 V <br />http://www s u[hbeaain gov/b'uvcrtutt¢nVd¢partmcnVcommuniry-ua es[ment <br />Phone 574/235 9371 Fax. 504/2359021 <br />.. Email. hpcabsjcQsouthb¢ndin_gov <br />Michel¢ GCIEmaa. President A C¢ttlfi¢d Local Gov¢mm¢m ¢fih¢ National Pad[ 3¢rvice Elicia Feasd. Hiamric Pi¢acrvation <br />Administmmc <br />APPLICATION FORA CERTIFICATE OF APPROPRIATENESS <br />OFFIG'E [!SF ONL)^ »»? T C MPLET R\ ONTAINED iN ccccOFFlCS VSE ONLY <br />OaY¢ Rac¢iv¢a: Appifcadon Number: — <br />Pas[ Ravicws: � YES (Dolt Sl'-o�Yt Ravta w) O NO <br />Stag Approval suYbociz¢d by, Tid¢= <br />Hiat¢ri¢ Pr¢s¢rvaH¢n Commission R¢H¢w Ost¢: <br />L.o¢al LnndmsrR O Locsl Historic OistricY (Naui sJ <br />National LanamarK O Nadonai R¢gis[¢r District (NnmU <br />C ¢,-tificat¢ OE App oor D¢nlad � Tabina O S¢nt To Committee O Approved and issued: <br />Address of Prop¢i'ty For proposed work: <br />So ..�� !mow( L� YG'6'e/ <br />/�/t /f /� //JJ (Street ry/,tuber.S'[reat N ¢�Cit)�G pJ / �j <br />Nam¢ of Pr'op¢r[y Own¢r(s): /rK(Xy MlL 4SGG� L'!St/ALL�fp P®ham �#I- S� bz TC -8 <br />Address of Prof¢+"tY OWn¢r(s) �� %� �i/PL't-t�C-L � '� � /� �v L <br />Nsme of Contractor(s): Phone #: <br />Contractor Compavy Nsm¢. <br />Aaaresa or cantra¢tnr company: <br />(Street NvmbeS¢eel Nam¢—Citi•—Zip) <br />[` / / f/ <br />Current Us¢ of BudaLng: tJ 4 � � � <br />ic,»o ,i.,, tl.,,wntri-Fom, comm¢rola[—Govcrnm¢nr—lndnstrtal—v cant—c1c.J <br />Trp¢ of Bndaing cnnatrneann: Li/ s cC /—( ��t�-� <br />(W ad Frn <br />Proposes WorKe (more than onr <br />y�Lartascapa <br />�C{-New 0 8¢plac¢m¢nt ( of In -Kind) <br />� Demolition <br />bot muy be clrecXedJ <br />..ea.,_:_.«,,,, »r Pr,...»eod w»rK_ 2 <br />-� L L/:. �L%. <br />/'� <br />OLG�es�-F-P/�G e_ _ .r. u -S % <br />t/ t/ <br />9 /. � _ <br />./ L _ _ LC <br />rtaPr C�at�a¢Ynr ¢-maLi- <br />9 ""ana/or x <br />Signature of Contractor <br />ar -sa s m.z oevumnen l os,ce m oma¢ er ou bcm reawouoa..mmca ,e pmJ�� ^^a m obm.n a awiama vwm...cm ea,mn. v pa mom.. <br />