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HISTORIC PRESERVATION COMMISSION <br />OF SOUTH BEND AND ST. JOSEPH COUNTY <br />County —City Building, South Bend, IN 46601 <br />http://www. southbendin. gov/government/department/community-investment <br />Phone: 574/235.9371 Fax: 574/235.9021 <br />Email: hpcsbsjc@southbendin.gov <br />Michele Gelfman, President <br />Adam Toering, Historic <br />Preservation Administrator <br />APPLICATION FOR A — CERTIFICATE OF APPROPRIATENESS <br />A Certified Local Government of the National Park Service <br />OFFICE USE ONLYS»»>DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX<««OFFICE USE ONLY <br />Date Received: <br />Application Number: <br />Past Reviews: ❑ YES (Date of Last Review) ❑ NO <br />Staff Approval authorized by: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark <br />❑ National Landmark <br />Certificate Of Appr_oE,riateness: <br />I Denied ❑ Tabled <br />Title: <br />❑ Local Historic District (Name) <br />❑ National Register District (Name) <br />❑ Sent To Committee <br />❑ Approved and issued: <br />Address of Property for proposed work: [ e eV A' 4.1.,41, Street L th _geoid ga k / S� <br />(Scree Number —Street Name —City —Zip) <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> - <br />5-1Z ?ss� <br />Address of Contractor Company: 3k/j /0E p( .a 1 0-61'A Fet . 4' 116 4"; I <br />Current Use of Building: <br />Type of Building Construction: <br />Proposed Work: (more than one <br />box may be checked) <br />(Street Number —Street Name —City —Zip) <br />/Aht. be <br />(Single amity —Multi Family —Commercial —Government —Industrial —Vacant —etc.) <br />fCc` 1, r,,9 19-VA*LI t <br />Mood Frame—Brick—Stone-5'teel—Concrete—Uthei) <br />❑ Landscape <br />❑ New <br />❑ Replacement (not in -kind) ❑ Demolition <br />Description of Proposed Work: fhipVe 5 1►I5 /41 / /di 5k4// Pe4- 11I.$JCC 5A-et !d. <br />rr y t17r t. C veld r"► /npvte.: r hg .45Pri,Lit Sit 45 <br />Owr; <br /> <br /> <br /> signing this application I agree to abide by all local regulations related to project and to obtain a Building Department Permit, if applicable. <br />