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Application <br />-TOR - <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 SBSJC 1PC@co.st josephinus <br />Website http://www.sgosephcoungindian&com/sjchp/index.html <br />OFFICE USE ONLY»»» DO NOT COMPLETE ANY ENTRIES CONTI NED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received 3 %yC,e► 4 401 D Application Number.4! <br />Past Reviews: BYES (mtevf[Mt'RevkW.) ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: <br />❑ Local Landmark Erfocal Historic District (Name) 64,ae V <br />National Landmark 2 National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied E] Tabled , E] Sent To Committee 2<Pproved and Issued <br />DATE <br />3 <br />Address of Property for proposed work: tn PA le .tz- <br />J St t Number and Street Name <br />Name of Property Owner(s): (please Print) _>e r 1 V e %A -V- <br />v <br />Address of Property Owner(s): i0 O 3 Pa P ow e <br />ontractor(s) Name: - M n f i.[- TCS WI P Le- _Ti2 t✓' G- S e J20 <br />tp Contract Company Name: ' V\A C- k- Tt% m P� � <br />Contractor ,Address: r� 2-� �' lj �C© b A r <br />City: 1 , l_ ► 6 Phone: 5-7 4 2 -73 -L2 -73-L 0 0 <br />Current Use of Building: -trr G W , hi <br />(Single Family - Multi -Family - Commercial -Government - Industrial -Vacant -etc.) ` <br />Type of Building Construction: Q-pvu(>.j14u el ti `t I VVI <br />(Wood Frame- Brick- Stone- Steel- Concrete- Other) A- Q-' O a C4- <br />n pesedWb , I Tn-4ind Q iandsrane r 1 New r-1 Replacement (not in-kind) n Demolition <br />(more than one bar may be checked) , f <br />Description of Proposed Work: t�(.c n 1zoL' P� (u r°'t �'n `�� 4 <br />�.0 v, u -,e [d_4;0 Ct � o � us (+� S + Q-ep 1G c_e ;/U 6 +r"*4f FP.o K T <br />0- - u-j� l C G ,S'/'j d 'N ety-S 1}- PPLG rL 1I.i tow le �RGK <br />Owner/Contractor: Fax: <br />,5'7 q-232-27 -5'1 e-mail t",-t�e,.� etc -v­eac <br />(This once WX correspond roith only one ' nee <br />X `IA 't and/or <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />