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Application <br />— FOR — <br />Cer0ficate of Appropfiateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />17.5 S. Lafayette Blvd., South Bend, Indiana 46601 <br />AX-2111fift Address: i ounty»City n ng,"xruth Tz,—A Indict, AA4ni <br />Phone. 574-235-9798 - F= 574-235-9578 - Emal- SWCHIMost -joseplLin.us <br />Website: ht[F//wwwstjosepkountN dbmcom/sjchp/index htrrd <br />OFFICE USE ONLY >>>>>> DO NOT COMPU77: ANY ENTRIES COAMINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received 16' Xd4Y 0201, Application Number <br />PastReviews: ErWS(Vte0f1M1xer*W) F1 NO <br />Staff Approval authorized by. 4 Title: <br />Historic Commission Review Date: <br />[]Local Landmark E31' )cal Historic District (vone) <br />n National Landmark [] National Register District (Name) <br />Certificate of Appropriateness: <br />C] Denied [] Tabled [] Sent To Conmdttee Q-,Kpproved and Issued <br />DATE <br />Address of Property for proposed work, <br />ShVd VWnber and Street Name <br />Name of Property Owner(s): (Please Print) Alin t, 061 <br />Address of Property Owner(s). 60 lhc., <br />Contractor(s) Name: <br />Contract Company Name: <br />Contractor Address: <br />City: <br />Current Use of Building: <br />Type of Building Construction: <br />Phone: 133—�4�q q <br />6 <br />(Wb&F==— Bra — Slow— Sted —Concrete —Other} <br />Proposed Work; q1n-kind [] Landscape 0 New <br />tmi than one box "tay be dedazi) <br />Description of Proposed Work: -- fcvk-1,r1 <br />Owner/Contractor. Fax: <br />71' ir <br />E] Replacement (not in kind) F1 Demolition <br />-qR�; <br />and/or <br />