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p: 1'2/02/2009 11:12 <br />Ip <br />5742359578 <br />HPC SOUTH BEND <br />Application <br />- FOR - <br />Certificate icate o f Appropriateness <br />Historic Preservation Commission of South Bend & SL Joseph County <br />125 S. Lafayette Blvd., South Bend., lndi=.A 46601 <br />Mailing Address: County -City Building, South Bend, Indiana 46007 . <br />Phone: 574-235-9793 • Pax: 574-235-9578 Ema 56SJCHPCco.st-)osc ph.in.t�s <br />Website: http://wuw.sqascphcounryindiana.com/schp/index.html <br />PAGE 01 <br />OFFICE USE ONLY >>> DO NOT COMPLE-M- ANY ENT.RrES CONMJNT.D INTHIS BOX >"> OkFICE tISE O.i.LY. <br />Date Received "% 7EG Zo a % Application Number <br />Past Reviews: �S (np�/tA F����Yi7 . 0 0 7 NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: 21 DEG Z-009 <br />❑ Local Landmark Qj Local. Historic District (Name)�'!��- <br />. -tr <br />❑ National Landmark ❑ National Register District Wamd <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and Issued i <br />- DATE I . <br />Address of Property for proposed work: <br />StrcctNwnberand Strccr Marne <br />Name of Property Owner(s): (Please Print) �-z= d <br />Address of Property Owner(s): U� ► ��G' 3't (jl V . //" !ff <br />T- <br />Contractor(s) Name: V".�:f�:�.� /� <br />Contract Company Name: d Q��-s�M-�+ <br />Contractor Address: <br />City: Phone: <br />Current Use of Btdl.ding: ��-�� '•<�? -=� <br />(Sindflc 9 mil Multi-F?ini i - Commrdal-(;nvvrnnrene - lndrutrlal - vaertnt - etc.) <br />Type of Building Constntction: � l(ti,,• <br />r (wood Framo - l:rl& - Stone - Steel - Concrete -()Flier) <br />Proposed Work: ❑ In-kind ❑ Landscape ❑ New W Replacement (not in-kind) ❑ Demolition <br />(more than one box my be lurked) f /f <br />Description of Proposed Work:�.�- <br />�.%--h 14- �jte_ <br />Owmer/Contractor. Fax: e-mail <br />(This -R carmpond with c�rlytnte dtsign) -- <br />V. . _ and/or <br />— APPLICATION REQUIRENI.ENTS ARE LISTED ON REVERSE SIDE — <br />