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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 />Mailing Address: County -City Building, South Bend, Indiana 46601 <br />Phone: 574-235-9798 • Fax: 574-235-9578 • Email: SBS)CHPC®co.st-joseph.in.us <br />Website: http://www.sgosephcountyindiana.com/sjchp/index.htinl <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX >»»> OFFICE USE ONI-Y <br />Date Received, , 11010 Application Number '10 1 0 - Dq 4'7_05 <br />Past Reviews: E] YES (Date of but Review) <br />Staff' Approval authorized by: <br />71175191 <br />Title: <br />Historic Commission Review Date: 02�t eOLb /D <br />Local Landmark [ Local Historic District (Name) ~+p i '��rk <br />National Landmark [National Register District (Name) 1 <br />Certificate of Appropriateness: <br />Denied E] Tabled E] Sent To Committee E] Approved and Issued <br />DATE <br />Address of Property for proposed work: W3 N •��� <br />s Street umber and Sheet Nal%l r.• <br />Name of Property Owner(s): (Please Print) VO/7l7 <br />Address of Property Owner(s): 17b s. /97,55Li �7 - <br />Contractor(s) Name: <br />Contract Company Name: <br />Contractor Address: <br />City: Phone: <br />Current Use of Building: 6))7-4 7e FGC./72i <br />(SingleFamily—Multi-Family— elommercial—Government— Industrial — Vacant —etc.) <br />Type of Building Construction: <br />(Wood Frame - Brick - Stone - Steel - Concrete - Other) <br />Proposed Work: �In-kind E] Landscape n New E] Replacement (not in-kind) n Demolition <br />(more than one box may he checked) <br />Description of Proposed Work: <br />V red/ate <br />- y <br />Owner/Contractor: Fax: <br />(This office Mill eorrespid with only ondesignee) <br />6-12. //11�cG8� <br />J --e riY.[.i l -j C/ 1- <br />��r�ei)l0u0- A(u m /11 k.h, <br />e-mail 'ea/� r'!U ad00 0,;'l zhoe" <br />v <br />(no --2) <br />v1^i CSC/ /r.l��J and/or <br />hlkn ea, b'an 6, <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />