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Application <br />- FOR - <br />CeW f icate 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 -TM • Fax: 574-235-9578 • Email: SBSJCHPC®rn.st josephan.us <br />Website: http://wwwsgosephcounVindiana ceif/gchp/hidex.htnd <br />OFFICE USE O DO NOT COMPLETE ANY ENTRIES CONTUNED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received»»» , 0 , 1' Application Number .9:9 L L - <br />Past Reviews: F1 YES (Date of G+st Review) ❑ NO <br />Staff Approval authorized by: C�i lJ �� �C 1 Title: <br />Historic Commission Review Date: 1/ <br />E] Local Landmark ] Local Historic District (Name) _616( 11'\ Pat- - <br />National Landmark National Register District (Name) <br />Certificate of Appropriateness: <br />Denied E] Tabled [] Sent To Committee Approved and Issued <br />DATE <br />Address of Property for proposed work: 1 FA r k /ive h v4_1 S o N't y b b (b <br />l Street Number and Street Name <br />k <br />Name of Property Owner(s): (Please Print) (, r h & it, a e ) P <br />Address of Property Owner(s): a bo v -c r 1< <br />Contractor(s) Name: Rr♦ "Tlra e55er <br />Contract Company Name: U h t' Je r S'. 1 Se r v t`c e S <br />Contractor Address: P• V. 13 o X D I Z3 <br />City: i 1 hi 6 b$ O Phone: 5 -7 4 2,31-654V <br />Current Use of Building: m t le K K. <br />(Single Family —Multi -Family — Commercial —Government — Industrial —Vacant —etc.) <br />Type of Building Construction: A—A yr 2 <br />(Wood Frame - Brick - Stone - Steel - Concrete - Other) <br />Proposed Work: In-kind ❑ Landscape [] New Replacement (not in-kind) ❑ Demolition <br />(more than one hoz may be checked) <br />5 (J e w a l k U "3 c k rb ) t !0 l h Lvv-ei S e VC rpt 1 <br />Description of Proposed I'Vork• <br />n e t �`� r`• S <br />Owner/Contractor. Fax: e-mail <br />(This office udli correspond udth only one designee) ' <br />and/or <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />