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-Application <br />' "OR - <br />Ce of Appropriateness <br />llisturicPre.s( South 13end&- St. jvsqjh County <br />: 2a S. Lafayette Bh%i., Smith Deed, bidia-.-o 4660 <br />Math Address: County -rit j b, <br />Buildin S-0 M—el Indiaro 46001 <br />Phone: 574-135-9M • F-ax:574-235-9578 • Email 5B5JCI1PC4,�koA-j0SCph ill. us <br />OFFICE USE ONLY>>>� DO NOTCOMPLUT ANTEMWIES CONIAEM I.Al T111.5 BOK �,» >>> OFFtCE USE ONLY <br />Date Received X44Wta Application Number <br />Past Reviews: [DYE.S(DkejWfRMM) <br />Staff Approval authorized by; <br />IWO: <br />Ifistork Commission Review Date _/ f 644 a <br />E] Local Landmark ['Local Historic District (:tame) <br />E] National Landtrmrk [] National Register District Winel <br />Certificate of Appropriateness; <br />Denied ❑ Tabled [] Sent To Committee 0 Approved and Issued <br />DATE <br />Address of Property for proposed work: <br />Name. of Property Owner(s)- (Plwsei <br />Address of Property Owner(s): <br />Contractor(s) Name: — 7 7 <br />Contract Company Name: <br />Contmr.tor Address, <br />City: I'llone <br />Current Use of Building: 3 r <br />fj <br />Family - Muth-Faftily - C , rdal - Gm.'ernmrnt - !r.jM,!rizil - vaoml - d:) <br />Type of Building Co list ructlon. <br />(Kxd T'ram­ Brick -Stlmf - Sleet - 01r,­:e' - 01hel) <br />roposed Work, O -kind ❑ Landscape New 9<eplacement (nn in-kind) i Demolition <br />e ore bul troy to CU6ej) <br />Description 6t Proposed %Nbrk: <br />ce 1 <br />f <br />tlLi ��, Ile, <br />LL <br />1 j" % i /51 k ) '�j 4�.. or tv. <br />AA,( "t Al <br />owner ;outractor: Fax: e-mall <br />and 'or <br />EMWES A RL 1.15TED ON RE VERSF Simi~ — <br />AM UC'Al'l(.).\ 'QuIrz <br />