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----------/ Michele Gelfrnan, President AUG 1 2 2020 ·1<.e�No, l 7573& :fa0,wmA <br />HISTORIC PRESERVATION COMMISSION <br />OF SOUTH BEND AND ST. JOSEPH COUNTY <br />County-City Building, South Bend, IN 46601 <br />http://\V\vw.southbendin.gov/govemment/department/community-investment <br />Phone: 574/235.7478 Fax: 574/235.9021 <br />Email: hpcsbsjc@southbendin.gov A Certified Loc al Government of the National Park Seivice Elicia Feasel, Historic Preservation Administrator APPLICATION FOR A-CERTIFICATE OF APPROPRIATENESS <br />OFFICE USE ONLY>»>»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLYDate Received: _______ _ Application Number: Past Reviews: D YES (Date of Last Review) __________ _ □ NO Staff Approval authorized by: ______________________ Title: _________ _ Historic Preservation Commission Review Date: ____________________________ _ D Local LandmarkD National Landmark D Local Historic District (Name) _______________ _ <br />D National Register District (Name) ______________Certificate Of p Pp!l!./·iaten ess: LJ Denied □ Tabled □ Sent To Committee □ Approved and issued: _______ _ <br />Address of Propert y for proposed work: -....,.370�£--�Y�l� .. _ _,_A,..._..,,...IO�f:..rlt-.Ji-,_,..�S�b�o=n,...,.E. __ �O�B�· ---��i�b�l_7�­(Slreel Number-Street :\,ame-City-Zip) <br />Name of Property Owner(s): _ __._P�frµ.UL.>L.,,.___C,,__,bo.. '-'-a...,L,_,_;�:S,._ ________ Phone#: (i z�) J-7 v-C/ l) "J....Address of Propert y Owner(s ): __ 3__,Q....,__,,oJ..S:::---l'---I ..... _.,_A....,....lo ..... l(......,_/-<-H ........... 5..,_k�c,....n ...... f' ____ _,Q._......,,e.._._. __ ___.L/Yi6,.:...-E,� .... ,_"7_ (Shet Number-Street Name-City-Zip) Name ofContractor(s): J1;;H&ez o;l;/l b':1 l Phone#: (sz0 )91 -;). '/9/ <br />Contmto, Company Nm, , / E::l?F i Q /� �I'� Address of Contractor Company: v ?) 4 = : · &a . $au fb &6 ,a(S/ree/ Number-Street .Vume.-City--Zip) Current Use of Bui lding: <br />Proposed Work: (111ore than one <br />box may be checked) <br />(Wood f rame 011crete-Othe1) �ndscape D New D Replac ement (not in-kind) D De molition <br />Owner e-mail: ______________ _ and/or Co <br />--------------------Signature of Owner <br />By signing this applicalion I agree to abide by all local regulations 1clatcd to project and 10 brmu a Building Department Permit. if applicable -APPLICATION REQUIREMEN TS ARE LISTED ON REVERSE SIDE- <br />8/12/20 2020 0910A <br />x West North Shore