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HISTORIC PRESERVATION COMMISSION OF SOUTH BEND AND ST. JOSEPH COUNTY County-City Building, South Bend, IN 46601 <br />http://w-.,vw.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 Park Service Elicia Feasel, Historic Preservation Administrator <br />APPLICATION FOR A-CERTIFICATE OF APPROPRIATENESS <br />OFFICE USE ONLY>>»»DO NOT COMPLETE .-\NY ENTRIES CONTAIN'ED IN 'rms BOX«««OFFICE USE ONLY <br />Date Received: _______ _ Application Number: <br />Past Reviews: DYEs (Date of Last Review) ___________ _ □ NO <br />Staff Approval authorized by: _______________________ Title: __________ _ <br />Historic Preservation Commission Review Date: _____________________________ _ D Local LandmarkD National Landmark <br />Certificate Of App�iateness: LJ Denied □ Tabled <br />D Local Historic District (Name) _______________ _D National Register District (Name) _______________ <br />D Sent To Committee □ Approved and issued: _________ <br />Address of Property for proposed work: 5'). 7 R, //l:PS!/121£ f) 12-. So l:uild o IN L/Uo / <br />(Street Number-Street Name-City-Zip) t..6,-?f'\Name of Property Owner(s): J..JCJJZJZ..LI C.., S CfftJ H- L Phone#: ;J.87 � � ¥ S <br />Address of Property Owner(s): __ _.5 ..... -', .... ift ....... H...,_,_fz....._ _________________________ _ (Street Number-Street Name-City-Zip) <br />Name of Contractor(s): ---�':i...-,,..il4-+-=-H_,__,/&...-,c... _____________ Phone#: ________ _ <br />Contractor Company Name: <br />Address of Contractor Company :-----------------------------------(Street Number-Street Name-City-Zip) <br />Current Use of Building: 5 I IY te L E .rxHL LY I/.E.J4/L {;>£12;4� (Single Family-Multi-Family-Commercial-Government-lnd11strial-Vacant-etc.) <br />Type of Building Construction: htooD EJg,Jt-Hli {Jt412,JtJ& £ -L) I:<& Nii-?'> r= Di'>0/2-(Wood Frame-B1·ick-Stone-Steel-Concrete-Othe1� <br />Proposed Work: (more than one <br />box may be checked) D Landscape B New D Replacement (not in-kind) D Demolition <br />Description of Proposed Work: 8 u, /....D ll &nl?.IA tl,E_ s 111-1 .ii Et> rJ..1.£ OLY4= f/;,LltL-r= tVI.£..,,(� O<t>o &. dt./ � Lolv'(a I t.1 � t4.11.[)£ £ / f kli c; LJ Ofy P/,t 12 Pl£/2T'1 ,4/ /11% 1 X /,,{ft I, I � r /l <br />Owner e-mail: -�-...,"----��------� r{:µ» and/or Contractor e-mail: ---------------- <br />and/or X ____________________ _ Signature of Contractor <br />By .signing this application I ag1ce to abide by all local regulations related to project and to obtain a Building Department Permit, ifapplicableT <br />-APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE- <br />4/6/20 2020 1113A12/21/20x River Bend