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Application <br />for. <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 South Lafayette Boulevard <br />Mailing address: 227 West Jefferson Blvd - South Bend IN 46601-1830 <br />Phone: 219-235.9798 Fax: 219-235-9578 amsil: sasacavcgc..-p.,t . <br />webdte:hIlp:11 wjoseplremtrlMWacomAlchpAnder.html <br />A Certified Local Government <br />y.el Wl tis N91 MMPI.P.TP. ANY ENTRIES coN'IINew IN TN1e A/IYa» DFPWE USE ONLY <br />Date Received o 7d ( 2005 Appilcatlon Number 2005- 0906 <br />Put Revtelss: ❑ YES (a.rsorusruwan ❑ NO <br />Staff Approval authorised by! / Title: <br />Historic Commission Review Date: %l1911005 <br />❑ Local Landmark ❑ National Landmark <br />❑ National Register District t : <br />O'Incal Historic District an.o: <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled Sent To Committee <br />❑ Approved and Issued 2005 <br />Address of Property for <br />proposed work:- 1711—tf lV, 1Y /•r -c <br />City: Dlik �iJ�d 1/�JOwner's Phone LNo: 57 I 'Z�J'1 � S I Y O <br />Name of Property Owner(s):RxtnNn '"I11(()fN1 //tSlWithDr� �GCumu— <br />Address of Property Owner : `73D P I Pm) <br />- I do 4&(191j(0 <br />Contractor(s) Name: T P A n Pm)`fIL <br />Contract Company Name: 1-lr3\n L- W Of -K --C, Ncrrwl� :LL INPRd✓LDt1EA/I <br />Contractor Address: 'rS Vvv A)K)SSI . City: YV\ \ t VA A W A K A <br />Contractor's Phone No: <br />Current Use of Building: 2(� 2 y/t yl <br />r <br />Type of Building Construction: <br />pl'.Mir.in.-anti-Sw.-FIJC.nv..-(hF <br />Proposed Work: ❑ Inkind ❑ Landscape g New ❑ Replacemento...+wa <br />❑ Demolition <br />Description of Proposed Work: S 1 `� 17 Q F A rL Pr,(.k <br />�/ n AL q o DEb TO ADD l i Itr l PegCkJ. , cl i/ eva<.e <br />CoTI S?eytLT1/n/ . 2 sroP.,5v' <br />Owner/Contractor: Fax: <br />SI amr rb/r��i 1qef Fax : S7c/ <br />-2Ti-I)K7 e-mail: QN i� <br />Tt�4l <br />/snm.oNa &tor - <br />Ibfdo Slgnatu"076trector <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE. <br />