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Sarah Andrews, President <br />MAY 2 9 2024 tvl <br />a1< 5 ac-).00 <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 />Ross Van Overberghe, <br />Historic 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) <br />❑ 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 Appro riateness: <br />Denied ❑ Tabled ❑ Sent To Committee <br />❑ Approved and issued: <br />Address of Property for proposed work: <br />[ 536 Li ee[v► ww�`} 61:1444-7144 <br />(Street Number —Street N me —City —Zip) <br />Name of Property Owner(s): W : 11 i t bl,ec Y (V% �j Phone #: S'% L# 33 3911 <br />Address of Property Owner(s): �,J <br />Name of Contractor(s): <br />Contractor Company Name: <br />Address of Contractor Company: <br />(Street Number —Street Name —City —Zip) <br />Current Use of Building: 0 MAMMA' C. a <br />(Single Family Multi -Family —Commercial —Government —Industrial —Vacant —etc) <br />5cot 4 our r Sa h1 ribt zP <br />(Street Number-Stre4po <br />me—Ciiy—Zip) <br />Type of Building Construction: <br />Phone #: <br />Proposed Work: (more than one <br />box may be checked) <br />Description of Proposed Work: <br />(Wood Frame —Brick —Stone —Steel —Concrete —Other) <br />ElLandscape ❑ New <br />Storm. door <br />Gil Replacement (not in -kind) ❑ Demolition <br />Owner e-mail: 01 <br />X <br />Signature of Owner <br />and/or Contractor e-mail: <br />and/or X <br />Signature of Contractor <br />By signing this application I agree to abide by all local regulations related to project and to obtain a Building Department Permit, if applicable. <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />