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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• SBSJCHPC@cost josephin.us <br />Website: http://wwwst osephcounVindima.com/s chp/indexhbnl <br />OFFICE USE ONLY >>>>>> DO NOT COMPLETE ANY ENTRIES CONTIINED lIV THIS BOX --.OFFICE USE ONLY <br />Date Received vl� �% - ( Application Number.9D L L - �221't <br />// <br />Past Reviews: 17YES (Date of Wt Review) � NO <br />Staff Approval authorized by: �� P Title: 6(d <br />Historic Commission Review Date: <br />Local Landmark Ej Local Historic District (Name) ajI <br />, �' 1 <br />National Landmark [] National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied [] Tabled ❑ Sent To Committee Approved and Issued <br />/ DATE <br />- Address of Property for proposed work: //0 A/ 4i -A SZ7-,/ / 330 0 • <br />,,. AIW— <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) �G �i �Q tn <br />ser�'nitoy G-�,e P �,�ic, s�t7-� <br />(r/ �•' f'Tu►'' <br />Address of Property Owner(s):, 3960 Ed;Se-n 6ke3 �►'�ti ,e.�cJ�I, /%%iSil a [J� $!i <br />Contractor(s) Name: Cr le 4 Se - i SS ?20 I%% n a g e e <br />i <br />Contract Company Name: /% l n of e17S; I7ee 2;n q <br />Contractor Address: Sot,36q .;-7 �e� 12Du�G , 933 <br />City. f �- Phone: �7�f 7.2 -10 ZO a <br />Current Use of Building: M444; ' 4 W + Ici <br />(Single Family -Multi-Faimily - Commercial - Government - Industrial - Vacant - etc.) <br />Type of Building Construction: <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />h , ` <br />Proposed Work: I:n-kind Landscape � New -nReplacement (not in-kind) F-1Demolition <br />(more than ox box may be checked) !� <br />Description of Proposed Work: K0WA- f 1V* 1y11►ta n Ca. c-sst- 91';G k / ,ak Pa ,-a l zti9 <br />-"/� <br />PA cue &- nd re4e- �, Res O'n C' � / 1 �/•�ti �w,%l req_ <3.3o GJ . <br />�p�t�PrG Aor-1 Mhl_d -fin, -9-2 &t 6"�k -77. SDG +el`/o�/%9 71 ls)•lh <br />Own r/Contractor: ax: 574 " Z SS - �1,3 Z% e-mail ti >7 d as kshar 0 7"li eS7'er/+'H 4 ? rA Com <br />(This t will rrespond n only one 1 <br />and/or <br />— APPLIC477ON REQZHREA ENTS ARE LISTED ON REVERSE SIDE — <br />