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Application <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St Joseph County <br />125 S. Lafayette Blvd, South Bend, Indiama 46601 <br />1�1allincr Address: County -GlyRij; C-1h Bend T-Aj— 4A6A1 <br />Phone: 574-235-9795 • F-=574-235JM • Email:Sl3SjCI-lPC4kwt+-mpWnus <br />Websih-- hUrr//wwws*)sephcminqindianaaoam/S <br />OM CE USE ONLY s » > DO NOT COMILLTE ANY ENTMES CON RINED IN 7711S BOX ---OMCF USE ONLY <br />Date Received - - --- V� <br />Application Number —G- <br />O <br />Past Reviews: ' 1.4 E] NO <br />Staff Approval authorized by. r Iltle: <br />Historic Commission Review Date.- <br />E] Local Landmark [Rll:o'ml Historic District {Name) <:5 <br />[_ ] National Landmark [] National Register District (maw) <br />Certificate of Appropriateness: <br />Denied [] Tabled ❑ Sent To Committee [Approved and Issued <br />fYA <br />Address of Property for proposed work: <br />Simt Numba and Sinxt Now <br />Name of Property Owner(s): (Fiaw prini) <br />Address of Property Owner(s): 5wi IF <br />Contractor(s) Name: Kebc-d <br />Contract Company Name. /JeA &�L A b t'P <br />Contractor Address: P-e /) Fx gir ti <br />city: Phone: a (0 <br />Current Use of Building: <br />Ilype of Building Construction: <br />(wed rnmw - Brki - stme - 5W - (:(*:wme - Otha) <br />Pmpo".d Work: In -kind FlLandscape [ _ toot inkinfi DDemolition <br />(morn - dwn tare hm rwy be dwtW) <br />D iption of Proptised )'cork: ,0 IA- Lf-, C -X(t u ee W,, 1AAe-k--, <br />Owner /Contractor: Fax e-mail 6 Mreer— A9 ya lte-e, ct / <br />(77m, vffirw Ung mmixtO u7th m�y twx dmNpmr) <br />and/or <br />— A1 REQUIREAMOIS ARE US= ON SIDL — <br />