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Sarah Andrews, President <br />PIAR 2 82024 RC.abi4Le4 c -a:w M+ <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-investment <br />Phone: 574/235.9371 Fax: 574/235.9021 <br />Email: hpcsbsjc@?southbendin.gov <br />A Certified Local Govemment of the National Patic Service <br />Ross Van Overberghe, <br />Historic Preservation Administrator <br />APPLICATION FOR A— CERTIFICATE OF APPROPRIATENESS <br />OFFICE USE ONLYS»»>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 />1-1 National Landmark ❑ National Register District (Name) <br />Certificate Of Appro riateness: <br />Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />Address of Property for proposed work: ` / to Re x 3+e e di f S. *i. et 4 d IA) t'l 1 6 I (r <br />(Street Number —Street Name —Cite. —Zip) <br />Name of Property Owner(s): ! Joan Du „ es S- K r e S 4 en K o <br />Address of Property Owner(s): <br /> <br /> <br /> 7'fumber—Street Name —City —Zip) <br />Name of Contractor(s): /4 a K C B cite/ ee C e /l;r..-1 fj foss <br />tj1oca4 <br />Contractor Company Name: <br />Phone #: 53'1. 2 i Sr(..$ Z. <br />Address of Contractor Company: <br />(Street Nwnber—Street Name —City —Zip) <br />Current Use of Building: S t ^ S / e F'a Me 1.7 <br />(Single Family—iYlulti-Family—Connnercial—Govermnent—Industrial-1 acant—etc.) <br />Type of Building Construction: JiJ o 4 d Ir e Ari e <br />(Wood Franie—Brick—Stone Steel —Concrete —Other) <br />Proposed Work: (more than one <br />box may be checked) <br />❑ Landscape <br />Description of Proposed Work: "The 6 es se rri e.i 4 <br />yroitert. <br />wor/1 <br />❑ New 10 Replacement (not in -kind) <br />wlndv..rS <br />❑ Demolition <br />q ..e 6 /ee.ke.4 oni <br />/ e tare *I.e. Awl a.•. f•k 9 `a Sc 6 to, /c . <br />Owner <br /> <br /> <br /> <br /> <br /> <br /> signing this application (agree to abide by all local regulations related to project and to obtain a Building Department Permit. if applicable. <br />