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Application <br />- FOR - <br />C rtiheats <br />Certificate of Approptiate ness <br />Historic Preservation Commission of South Bend & SC Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />M -011n ArtArmmn county-CityVvjT_4tq CZovflk Ra"A Indiana 46601 <br />Phone: 574 -235 -TM 9 I= 574-23,5-9578. # Email: SBSjCHPC&ost-joscphin.us <br />Website: bttp.//i,a,NNivsqosephcoun4indiana.com/s chp/indexhW <br />OMCE USE ONLY >>>>>> DO NOT COMPLETE ANY ENMIES COMAMED IN 77115 BOXOMCE USE O'VLy <br />Date Received /'�I? C;20/" Application Number -Zd / e) . Z <br />Past Reviews: Ej YES (Date cl u4t xr,*-x) Ej NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: <br />PLocal Landmark 0 Local Historic District (Name) <br />[] National Landmark [] National Register District (lvamr) <br />Certificate of Appropriateness; <br />[-I Denied E] Tabled F1 Sent To Committee � Approved and Issued <br />Address of Property for proposed work: z/ 11,1h <br />St tW) =smdStrerf Name <br />Name of Property Owner(s): (Please Print) <br />Address of Property Owner(s): J U <br />Contractor(s) Name: <br />Contract Company Name: <br />Contractor Address, <br />1Z 7—A,,ff XO 14 <br />DATE <br />City: Phone: <br />Current Use of Building, S 11'rL_ - <br />(Single ramify -M i -F 'y- corimercial- Government -Industrial -Vacant - tic.) <br />Type of Building Construction: <br />(WWd Frame - Brick - Stone - Sted - Concrete - Wer) <br />Proposed Work: In-kind Landscape New Replacemely (not in-kh,:d) F1 Demolition <br />(mm than one fox may to diccW) r" <br />Description of Froposed Work:C'C. <br />til <br />Owner/Contra Fax: e-mail <br />M;�of Wt - *IM0111y - <br />and/or <br />