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Application <br />- FOR' <br />Certi f icate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46601 _ <br />Mailing Address: County -City Budding, South Bend, Indiana 46601 <br />Phone: 574235 -W% - Fax♦ 574- 235 -9578 - Email: SBSJCHPC ®m st josephin.us <br />Website: http-//www.slosephcountyindiana.com/sI chp/inde <br />a - <br />OFFICE USE ONLY > »» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX »» > , OFFICE USE ONLY <br />Date Received = 00- <br />0 Application Number Q q- v`1 , lfl <br />Past Reviews ❑ YES (Date of Gast Review) <br />Staff Approval authorized by- <br />SIM <br />Title: <br />Historic Commission Review Date: p n <br />❑ Local Landmark cal Historic District (Name ►Y V <br />❑ National Landmark ❑ National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and Issued <br />DATE <br />Address of Property for proposed work: UPI G O T 7F /- I ZF <br />Street Number and Street Name <br />Name of Property Owner (s) (Please Print) A / 6" 1 5/A re-,A 'EA J U t(0 <br />Address of Property Owner(s): 1,Am,otj7r, 7B UACP <br />Contractor(s) Name: d w <br />Contract Company Name: <br />Contractor Address: <br />City: Phone: <br />Current Use of Building: <br />(Single Family — Multi- Famt7y— Commercial — Government — Industrial — Vacant —etc.) <br />Type of Building Construction: w,5b FP—,dm C <br />Pr, n)Gf�= wl kjo oloT> ' +ZEN c &or t L' - Pty t�a7 i P�,mvV C ti w)) ' SA V 6 <br />t S l N t 7 W t ND d1N r i 1 Jci"17J L, �' iS h x, H b 0612,9 w[_772,II Al �. f it/ ETA l <br />S MA G-t, k(W C Y CA "d r Y P ME" <br />Owner /Contractor: Fax e-mail <br />(� wi, correspond with only one designee) <br />�4- •� � and /or - <br />— APPLIC477ON REQIIIREME M ARE LISTED ON REVERSE SIDE — <br />(Wood Frame — Brick— Stone — Steel — Conmte — Other) <br />Proposed Work: In -kind ' �A Landscape "* p New Replacement (not in -kind) Wemolition <br />(non: than one box may be choked) <br />Description of Proposed Work: Wiv WM - DEc-K FLFPLAc1&)& C/4.4 /N L /Ajl<— <br />