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f` p b.) a, 5oaL-1 <br />�e e.. (41-15 8 TO. Dn <br />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-inves tment <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 ONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY <br />Date Received: <br />Past Reviews: <br />Application Number: <br />❑ YES (Date of Last Review) ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark ❑ Local Historic District (Name) <br />❑ National Landmark ❑ National Register District (Name) — <br />Certificate Of Appj <br />riateness: <br />Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />Address of Property for proposed work: 1 C' 3 LLJ= 1 I O Kra kJ 1 RE D K •l 5t/. 0-EN t) A/6617 <br />�7 (Street Number —Street IVarnc—City—Zip) ` <br /> <br />Address of Property Owner(s): I L%45 IA). NO kr-1-. 5 HC Z E l Sot..7' ( 13EN (6 / { <br />(Street Number —Street Name —City —Zip) <br />Name of Contractor(s): ( 1 K. 2141, m k R <br />Contractor Company Name: C.DL L,.1 E Q :5' C3 L K1 S.5 e oaW. <br />Phone #: <br />Address of Contractor Company: 16,23g £ O-EWao ❑ �7 P�T'�) Fl P1 Al (06, ) <br />p 1 �. (Street Number —Street Name —City —Zip) <br />Current Use of Building: i/ 1 luG-L,`}lf 1). <br />(Single Family Multi-Family—Commercial—Goveryyn��ment—Industrial—Vacant—etc.) <br />Type of Building Construction: �LOWE R. eR.(gK/teaoD t If7 m SEGO' <br />(Wood Frame --Brick—Stone-121Steel—Concrete—Other) <br />❑ Landscape ❑ New ❑ Replacement (not in -kind) ❑ Demolition <br />Proposed Work: (more than one <br />box may be checked) <br />Description_of Proposed Work: <br />1) <br />ram, <br /> <br /> <br /> <br /> <br /> <br /> <br />