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x12/0212009 15:10 <br />5742359578 <br />HPC SOUTH BEND <br />Application <br />-FOR- <br />Certificate of Appr©ptiateness <br />Historic Preservation Commission of South Bend & St Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana, 46601 <br />Mailing Address: County City Badding, South L3end, Inda�,na 466ttI <br />Phone: 574-23:-9M - • Fax: 574-235-9578 • Email: SBSJCHPCQko.st josi.Tt0n.us <br />Website htV://www.stjosephcountyindiam.com/Ichp/index-.htrni <br />PAGE 01 <br />OFFICE USE ONLY »>r DO NOT COMPLM ANY EMIES CONTAINED IN THIS ,BOX »»» OFFICE USE ONLY <br />Date Received % 20c? Application Number iao— °1 - 11,01 <br />Q1 <br />Past Reviews:S (ruo/Lot Review) G% J 0 NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: <br />❑ Local Landmark Local Historic District {Name)Yc.�_. <br />[� NationaI Landmark (� National Register District pVame' <br />CerWcate of Appropriateness: <br />rj Denied ❑ Tabled ❑ Sent To Committee rj Approved and Issued <br />DATE <br />Address of Property for proposed work- <br />/� fStrut Nbcrand Street Name <br />Name of Property Owner(s): (FreAn Print) 4 t l <br />Address of Property Owner(s): /e,7 5" It +r'r's:rCi %z?c , ��� r ,- jr-7 41alz <br />Contractor(s) Name: t7 r r r l W 0'& rfV $ r <br />Contract Company Name: A, <br />Contractor Address: le)!Yo E. F,,a/�rf<, <br />City: %�i t/�tK� Ti" '�i'S h� f'i=aG <br />I'lzozle: <br />Current Use of Building: t t <. <br />(Single Iamiry - Muni-Famiry- Commercial - Government -• Industriar -Vacant - do <br />Type of Building Construction: t/r't J"k - <br />(Wbad Frame - rt rick - Stam. - Sher - Cancrele -tither) <br />Proposed Work: ❑ In-kind XLandscape ,rNew ❑ Replacement (mat in-kind) n Demolition <br />6rtorr than ane hoz may be ) <br />Description of Proposed Work: �Gt A4 . c) T u. j/� +%+� ^' � �/ �7lc� F1'A"' <br />/V' Aee- i#1 �hi 7/ro � �//t t's� Q f" 124 lt�r t T i"j'�,✓ A e -e <br />le, A <br />y� V / <br />OwnerlCo�trI6or. Fax: a'�/-?r�Us a -mail /��/�r Ill�j �j-A; <br />(17ti< office tor71 ccrri%TAT' h pity one darg ' <br />r - <br />- - APPUCA77ON REQF,J.TP,EMENTS ARE LISTED ON REVERSE SIDE -- <br />