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HISTORIC PRESER9ATION COMMISSION <br />OF SOUTH BEND AND ST. JOSEPH COUNTY <br />Count\²Cit\ Building, South Bend, IN 46601 <br />http://www.VRXWKEHQGLQJRYJRYHUQPHQWGHSDUWPHQWFRPPXQLW\LQYHVWPHQW <br />Phone: 574/235. Fax: 574/235. <br />Email: KSFVEVMF#VRXWKEHQGLQJRY <br />0LFKHOH*HOIPDQ,3UHVLGHQW A CHUWLILHG LRFDO GRYHUQPHQW RI WKH NDWLRQDO PDUN SHUYLFH Elicia Feasel, +LVWRULF3UHVHUYDWLRQ <br />$GPLQLVWUDWRU <br />OFFICE USE ONLY>>>>>>DO NOT COMPLETE AN< ENTRIES CONTAINED IN THIS BO;<<<<<<OFFICE USE ONLY <br />DDWH RHFHLYHG: B___________________ ASSOLFDWLRQ NXPEHU: ____________² <br />___________________________________ PDVW RHYLHZV: <ES (DaWe Rf LaVW ReYieZ) _____________________________ <br />NO <br />SWDII ASSURYDO DXWKRUL]HG E\: _________________________________________________________ TLWOH: __________________________ <br />HLVWRULF PUHVHUYDWLRQ CRPPLVVLRQ RHYLHZ DDWH: __________________________________________________________________________ LRFDO LDQGPDUN LRFDO HLVWRULF DLVWULFW (Name) ________________________________________ <br /> NDWLRQDO LDQGPDUN NDWLRQDO RHJLVWHU DLVWULFW (Name) _____________________________________ <br />CHUWLILFDWH OI ASSURSULDWHQHVV: <br /> DHQLHG TDEOHG SHQW TR CRPPLWWHH ASSURYHG DQG LVVXHG: _____________________ <br />AGGUHVV RI PURSHUW\ IRU SURSRVHG ZRUN: ________________________________________________________________________ <br /> (SWreeW NXmber²SWreeW Name²CiW\²Zip) <br />NDPH RI PURSHUW\ OZQHU(V): __________________________________________________PKRQH #:______________________ <br />AGGUHVV RI PURSHUW\ OZQHU(V): BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB <br /> (SWreeW NXmber²SWreeW Name²CiW\²Zip) <br />NDPH RI CRQWUDFWRU(V): _______________________________________________________PKRQH #:______________________ <br />CRQWUDFWRU CRPSDQ\ NDPH: __________________________________________________________________________________ <br />AGGUHVV RI CRQWUDFWRU CRPSDQ\: ______________________________________________________________________________ <br /> (SWreeW NXmber²SWreeW Name²CiW\²Zip) <br />CXUUHQW 8VH RI BXLOGLQJ: _____________________________________________________________________________________ <br />(Single Famil\²MXlWi-Famil\²Commercial²GoYernmenW²IndXsWrial²VacanW²eWc.) <br />T\SH RI BXLOGLQJ CRQVWUXFWLRQ: ________________________________________________________________________________ <br />(Wood Frame²Brick²SWone²SWeel²ConcreWe²OWher) <br /> LDQGVFDSH NHZ RHSODFHPHQW (noW in-kind) DHPROLWLRQ PURSRVHG :RUN: (more Whan one <br />bo[ ma\ be checked) <br />DHVFULSWLRQ RI PURSRVHG :RUN: _______________________________________________________________________________ <br />___________________________________________________________________________________________________________ <br />___________________________________________________________________________________________________________ <br />___________________________________________________________________________________________________________ <br />OZQHU H-PDLO: __________________________________ DQG/RU CRQWUDFWRU H-PDLO: ___________________________________ <br />; _______________________________________________ DQG/RU ; _______________________________________________ <br />SLJQDWXUH RI OZQHU SLJQDWXUH RI CRQWUDFWRU <br />B\ signing this application I agree to abide b\ all local regulations related to project and to obtain a Building Department Permit, if applicable. <br />²APPLICATION REQ8IREMENTS ARE LISTED ON RE9ERSE SIDE² <br />APPLICATION FOR A ² CERTIFICATE OF APPROPRIATENESS <br />319 W. Navarre St., South Bend, IN 46616 <br />Tom & Mary Casteel 574-807-2019 <br />319 W. Navarre St., South Bend, IN 46616 <br />Hoosier Siding & Construction 574-674-5599 <br />Hoosier Siding & Construction <br />30471 Old U.S. 33, Elkhart, IN 46516 <br />Single Family <br />Wood Frame <br />X <br />Window replacement - SEE ATTACHED <br />tomcasteel@live.com <br />T & My Casteel <br />Rec. No. 175782 $20.00 <br />Dec. 10, 2020 MA <br />2021 01041/4/2021