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J• <br />Application <br />.FOR - <br />CeMf;cate ofAppropriateness <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND do ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, TM 46601 <br />httpd/www.s§osephcountbdiamcom/departinenWSJCHPrmdcx.htm <br />P: 574 - 235 -9798 E 574- 235.9578 e: SBSJCHPC&O.st joseph.in.us <br />t mcr USBomrx> ceacuOFFlCB [lSBONLY <br />Date Recelved: /V %& e7- APPUa a1 0 /ot — • U 7 / 0 <br />Past Reviews: v �YES pwaffwRednrl 9 .ZG /d ❑ NO <br />Staff Approval authorised by: /7, Title: �1llt <br />HWrlc Preservation Commission Review Date: / ' l <br />❑ Local Landmark Local Historic District (Nm ,) <br />❑ National Landmark aNsdonal Register District pVied <br />Certiticate of Appro rlatenen* /d j ".70 /Z <br />Denied ❑ Tabled ❑ Sent To Committee Wpproved and Imed: <br />are Print) <br />— ddress of Property for proposed work: <br />A Mmet Number— Street Nam —City —Zip Code) <br />C <br />Name of Property Owner(s): F T& Al "' A FAQ IZC�G - W Phone #: <br />Address of Property Owner(s): SA-M <br />•-•,� ( Street Nran6er•— Street Name -- City —Zip Code) <br />14 <br />Name of Contractor(:): 1f4J�1 ONA_ - j Phone #: 67 L) 0 ? � �5 <br />Contract Company Name: PIMAR'r%*t')C)� <br />Address of Contract Company: <br />Current Use of Building: <br />Z7 KI , <br />n L Tv vv cx��wo et�,> <br />je4. <br />( Street Number — Street Name —City —Zip Code) <br />s1o6t- ' FA"114 <br />(Single Famil y-"MultPFami ly— Commemial— Gamment--lndustrW— Vacant — etc.) <br />Type of Building Construction: \W MD <br />'(Wood Frame —Bric1 E•�tone— SYee�Concrele= •Other) <br />Proposed Work: In-Kind ❑ Landscape ❑ New ❑ Replacement (not in -IintO ❑ Demolition <br />(more than one box be checked <br />Description of Proposed Work: 51 -10�F <br />Owner /Contractor Fax #: <br />(Staff will correspond with only one designee) - <br />X <br />Signature of Owner <br />s t M KIA)e) • P-b?C4 • t T <br />e-mail: <br />and/or X llgLl1 <br />Signature of Contractor <br />{ NTS ARE LISTED ON REVERSE SIDE- <br />