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HISTORIC PRESERVATION COMMISSION OF SOUTH BEND AND ST. JOSEPH COUNTY County-City Building, South Bend, IN 4660 I http://www.soul h bend in .gov/govern ment/depa11men t/com 111 unity-investment Phone: 574/235.7478 Fax: 574/235.9021 Email: hpcsbsjc@southbendin.gov Michele Gelfman. President A Certified Local Government of the National Park Service Elicia Feasel, Historic PreservationAdministrator APPLICATION FOR A-CERTJFJCATE OF APPROPRIATENESS <br />OFFICE USE ONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«<<«OFFICE USE ONLY <br />Date Received: _______ _ Application Number: <br />Past Reviews: □ YES (Date of last Review) ___________ _ □ NO <br />Staff Approval a uthorized by: ________________________ Title: __________ _ <br />Historic Preservation Commission Review Date: ______________________________ _D Local LandmarkD National Landmark <br />D Local Historic District (Name) ________________ _D National Register District (Name) _______________ _ <br />Certificate Of App�iateness: LJ Denied □Tabled 0 Sent To Committee D Approved and issued: _________ <br />Address of Property for proposed work: <br />Name of Property Owner(s): k� w�"""' � ..ka,..fe.__ fllK,L,� <br />Address of Property Owner(s): _---<;s:.....L'-A:JM'--"-"'-'-'-1:£..�--1l0As'--:-:'.'--+A-B--->=--c-.;-J..11J..tE_._,.__ ________________ _ (Street Number-Street Name-City-Zip) <br />Name ofContractor(s): LJro, Phone#: Qµj)2>1t-,-q'o� Contractor Company Name: <br />Current Use of Building: <br />(Sing/ mily-Multi-F a mil '-Commercial-Government-Industr ial-Vacant-etc.) <br />Type of Building Construction: ---l;L-l"J<d--"�"-='"'-L./----:�t:---:-"--'-':-":::--.c,,,,.--"c'::-----:---::------:---,----------------­(Wood Frame-Brick-Stone-Steel-Concrete -Othe,) Proposed Work: (more than one <br />box may be checked) D Landscape D New D Replacement (not in-kind) <br />0""lr 0 • �ose •r•,' f.r�rn ± �� p, ., �� .,,,,(Q; I<)� ,, �t-L. I b <br />Owner e-mail: k,YlN,....-� tl�, 4< and/or Contract <br />x ___________________ _ Signature of Owner <br />D Demolition <br />By signing 1his applica1ion I agree 10 abide by all local rcg11la1io11s 1cla1ccl 10 projccl and 10 obiain a Building Dcpa11111c11t Permit, if applicable. <br />A DD I Ir AT 111 N DC" 111 11 DC" 1\11 C" NT C A D C" I IC TC" r\ 11 N DC"\/ C" DCC" CI r\ C" <br />12/15/20 2020 <br />x <br />x <br />Chapin Park <br />Chapin Park <br />Dec. 16, 2020 MARec. No. 175783 $20.00 <br />Forest <br />1221 <br />Elicia Feasel HP Administrator <br />n/a <br />x <br />12/21/20