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Application <br />- FOR - <br />Certificate 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 Building, South Bend, Indiana 46601 <br />Phone: 574-235-9798 • Fax: 574-235-9578 • Email: SBSjCHPC@co.st joseph.in us <br />Website: http://www.sgosephcountyindiana.com/s chp/index.html <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONTUNED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received 72>05-5c, 2-001 Application Number 4 O O ? - /.Z6 7/6 <br />Past Reviews: Z"YES (Date of imt Reoiero) <br />Staff Approval authorized by: <br />Historic Commission Review Date: <br />lu LY, .2o09 E] NO <br />cZ/ 2>EG 2-11-0'? <br />Title: <br />rj Local Landmark[✓]Local Historic District (Name) G• �i�`` �i <br />n National Landmark National Register District (Name) <br />Certificate of Appropriateness: <br />Denied n Tabled ❑ Sent To Committee n Approved and Issued <br />DATE <br />Address of Property for proposed work: I % o q E. <br />Streea tWumber and Street Name <br />Name of Property Owner(s): (Please Print) t � _PoCc'2NAA T�lGke_l <br />Address of Property Owner(s): M4 Va h p �. 070 i� tG� imcQ ..iV y(o1Q / 5 <br />Contractor(s) Name: )?/ .ASoo-If <br />c - <br />Contract Company Name: . 70 H = c50Y, (?0-), e& f, -U C_ -f frn <br />Contractor Address: ckq rj & L&u Se, L4,-jE <br />City: Phone: S74t-,R9/ , 771,3" <br />Current Use of Building:---Am"Oks�.r1"J <br />Sing Fily Mu <br />amlti-Flmily — Commercial —Government —Industrial — Vacant —etc.) <br />Type of Building Construction: 0("d <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work: (' In-kind [:] Landscape ❑ New [Replacement (not in-kind) [] Demolition <br />(more than one box may be checked) (` <br />_Description of Proposed Work: 0&,a o e_ Trt)n4 �_7j c.� _Nnr CUL W00dj4*ju r <br />door � <br />I ' r l� back use.- rz rL Wod .eco r- <br />r�o r <br />Owner/Co or: F • e-mail <br />(This offt' ! �thoyne ) <br />and/or - <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />