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UMM= <br />-FOR- <br />v <br />Certificate ofAppropriatenes, <br />Z' <br />HISTORIC PRESERVATION COMINILSSION <br />65 of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />littp:Hw-*N-w.stjosepticountyindiana.cotii/depirtments/.SJCIIP/index.htm <br />p: 574-235-9798 r- 574-235-9578 e: S13SJCI.II"C(a,)co.st-joseph.in.us <br />. . . .. .... . - � ''.. I,....,.".'' ­'.�­' ...' ,,, 111". ", .1, ­'d'!.J'!'" . ... .. . 1. 1-11 11 1 ''1 11.11.1. 1� „1.1111111.11_111 ­.­­ I 1 .11, 1111 1 ''. <br />OFFICE VSFI NOTC0101,1117", ANV M17 RIES CONTAINED UNTITIS R0X<<<<<<0MCF1TSE ONLY <br />Date Received: 0203 <br />Application Number: >'Z'I 13 ee- Z 7 <br />Past Reviews: f YF ❑NO <br />Staff Approval authorbwd by: <br />Title: <br />- I listorie Preservation Commission Review Date: 16- dtz� <br />Lai <br />Local Landmark n [ACal Historic District (same) <br />❑ National Landmark ❑ National Register District vvvn4 <br />Certificate of Appropriateness: <br />nDenied E] Tabled E] Sent To Committee El Approved and issued: <br />(Please ptint) <br />Address of Property for proposed work: 0-Y S. <br />mm <br />rm i k� <br />tri in Yer—Sireel Natne--Go�---Zip Carle) <br />Name of Property Owner(s)- Phone �aL'�,50 3 KJOtz, <br />Address of Property Owner(s): <br />(.Street Number— Stivel Name—City--Zip 0x1e) <br />Name of Coutractor(s): <br />Contract Company Name: <br />Address of Contract Company: <br />{Street Number Stmet 1Vame— ITIV--Zip Code) <br />Current Use of Building-. <br />Type of Building Construction: __W_C_X X)Rancip, <br />(lVomf Fram(—I3rick—.5ion"teet—totterett—011ier) <br />Proposed Work: ElIn-Kind Landscape n New FIReplacement (not ht-kiml) ❑ Demolition <br />(more than one bax niqv he checked) <br />Description of Proposed NVork:—Ceno cy f 4---t <br />P <br />Ice,_ <br />C217-= <br />cod <br />Owner/Contractor Fax <br />Co <br />[.ng 1-4— and/or X <br />Signature of Owner( k V___ I I � Signature of Contractor <br />QUIRENJENTS ARE 11,19FED ON REVERSE SIDE- <br />