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1 <br />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 />Maitittg Address: County City Building, South Bend, Indiana 4E01 <br />Phone: 574-235-W% • Fax: 574 -?35-957$ • Email: S139CH13C&ost josephin.us <br />Website: http://wwwsgosephcountyindiana.corn/ochp/index.htnil <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONMINED IN T711S BOX »»» OFFICE USE ONLY <br />Date ReceivedjUnf ,� 12010 Application Numbera l0 - V � l> <br />Past Reviews: (5q YES (Datca/lflst Review) <br />Staff Approval authorized by: <br />Title: <br />Historic Commission Review Date: aw. 7,1 � fl,,, <br />[j Local Landmark. Local Historic District (Name) f, 4t � Y.�{ <br />[] National Landmark (] National Register District (Name) <br />Certificate of Appropriateness: <br />[] Denied [] Tabled E] Sent To Committee R Approved and Issued <br />DATF <br />Address of Property for proposed work: <br />%.,'_ ---� St t weber i nd St r N <br />Name of Property Owner(s): (Pimse Print) jV `� _ :i (. , <br />Address of Property Owner(s): 8114 Al2 Avi, r44-4.0 <br />Contractor(s) Name: �Vt J 14 elW ro, ,7 <br />Contract Company Name: 4jC111ro r7 <br />Contractor Address.% /, /"r .rr _. <br />City. A r 11u-crr+ Ix %�lv Phone:S .f = 2 fes' r <br />Current Use of Building: ! . 1-e ) , <br />Ingle icy— Iii-Fami y — Commercial — Gmxrrment — Industrial — Vaunt —etc..) <br />Type of Building Construction: I (t.0 <br />{ Dort France — Brick — St — Steel — Concrete — Other) <br />Proposed Work: E] In-kind n Landscape . E] New Replacement (not in-kind) E] Demolition <br />:mare«' <br />Descri tion of Prop sed Work: 4j6.(r1iXi`A r <br />IiLc 1�+�'1�u t.viWtp 54, <br />Owner/Contractor: <br />(this0'�4 1 pmpond <br />-- APPLICATION <br />�o —tata,tt. cr)"J, <br />ARE LISTED ON REVERSE SIDE — <br />