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Application <br />f� \ - FOR - <br />�Xm Certificate ofAppropriateness\FCF <br />y <br />;0.- <br />- <br />r — ' x HISTORIC PRESERVATION COMMISSION. <br />1865 of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, fN 46601 <br />http://www.stj osephcountyindiana.com/departments/SJCHP/index.htm <br />p: 574-235-9798 f: 574-235-9578 e: SBSJCHPC@co.st-joseph.in.us <br />. , . <br />OFFICE USE ONLY-- ­D0 NOT COMPLETE ANY ENTRIES CONTAINEDINTHIS BOX«««OFFICE USE ONLY <br />Date Received: Application Number: lXO1 — 0907 <br />Past Reviews: VJ YES (Date of Last Review) 2005, 0715 ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: <br />❑ Local LandmarkLocal Historic District (Name)i1i�l�II�P, t►IrIJ2 <br />❑ National Landmark ❑ National Register District (Name) <br />Certificate of Appropriateness: <br />ElDenied ❑ Tabled ElSent To Committee ❑Approved and issued: <br />(Please Print) /� <br />Address of Property for proposed work: 107 ( K.i Lt ll'�,. 0". &,.L -:?:7,17 <br />(Street Number— Street Name—City—Zip Code) <br />Name of Property Owner(s): P""' t "I'_31 _1 Phone #: Z� / s 0 %n � <br />Address of Property Owner(s): jke4r.L1 tkA\ Or,mo, 1 l�%` iij T912-() <br />(Street Number— Street Name—City—Zip Cdde) <br />Name of Contractor(s): � -_}—r.r-'_eJ4 <br />Phone #: 4::q7e/ X7.0 2,Z70 <br />Contract Company Name: J{ el ,ti—rN-,l ✓� ► ; ;�,. (`� <br />Address of Contract Company: ? -7 t) Z m l <br />(Street Number— Street Name—City—Zip Code) <br />Current Use of Building: Sr .� /'__'`� �.v+ , (� <br />(Single Family—lditlti-Family-Commerc aal—Government—Inditstrial—Vacant—etc) <br />Type of Building Construction: <br />(Wood Frame—Brick—Stone—Steel—Concrete—Other) <br />Proposed `York: ❑ In -Kind 1:1Landscape ❑ New © Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed `York: &i k � `Qty," L" Ll to , w-.._, <br />r_!-t <br />II r.1/f, ,t�.n �ri�vk t✓,.. ton // <br />A ! , ;'t�7� k"_S �/4 UJ -2� �_ P_,�,n �i�ZJ tie+ -1 /�f''�'�ed <br />Owner/Contractor Fax #: e-mail: r <br />(Staff will correspond with only one designee) <br />X and/or X <br />Signature of Owner Signature o ntr / <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />