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Application <br />- FOR - <br />CerUftcate of Approptiateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 S. Lafayette Blvd., South Bend, Wim 4&01;: <br />MaltingAddress;Coonty-Cty Building mouth U—A T.A,.,n, AAMI <br />Phot -z574 -2&%-M, * F=574 -2r) -M <br />Website: <br />OFFICE USE ONLY »>r» DO NOT COMPME ANY EIVU.MS CONMED IN TWS BOX OMCE USE ONLY <br />Date Received--,'/—" Application Number <br />W If <br />Past Reviews: B'ftS(VWejLMR=k,) It 7"4 NO <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: <br />C] Local Landmark Historic District (Nome) <br />National Landmark National Register District Wame) <br />Certificate of Appropriateness: <br />C] Denied []Tabled [] Sent To Committee Approved and Issued <br />DAU <br />. . .... ... .. xiUil <br />Address of Property for proposed woik-.-� <br />Street Sumba And stmt 144M <br />Name of Property Owner(s): (mat Print) M <br />Address of Property Owner(s): <br />Contractor(s) <br />Name: <br />Contract Company Name: 4 <br />Contractor Address:- �, 4, o OSh, /,r4 7P" <br />City. 4/ Phone. <br />' <br />Current Use of BuildinLr )VAI XY, <br />(sinSte Amu7y Wti-Family — Can W Go= <br />m' <br />`Type of Building Construction: <br />(Wood Frame-Brick—Stone—Suet' CM=ff — Otha) <br />Proposed Work 0 In-kind 0 Landscape New 0 Replacement (not in-k6d3 0 Demolition <br />On than one b" mV be dwW) <br />Description of Proposed Work., <br />Owner/Contmctor. Fox e -mall <br />arid/or <br />APPZONREQLUREMEIVM ARE LISM ON REVERSE SIDE <br />