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Application <br />-FOR- <br />Certificate ofAppropriateness <br />Appropriateness <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, IN 46601 <br />http://www. stj osephcountyindiana.com/departments/SJCHP/index.htm <br />p: 574-235-9798 f 574-235-9578 e: SBSJCEFC@co.st-joseph.in.us <br />OFFICE <br />USEi/j <br />OANLY»»»MP <br />DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX« <<—OFFICE USE ONLY <br />Date Received: dWu U (� i-1 Application Number: Z o n — 0-1 () �0 <br />Past Reviews: 1ETYES (Date of Last Review) R14.117 - ❑ NO <br />Staff Approval authorized by: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark <br />❑ National Landmark <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled <br />Title: <br />July f"1 <br />EV Local Historic District (Name) <br />National Register District (Name) ® e <br />❑ Sent To Committee ❑ Approved and issued: <br />(Please Print) �% <br />Address of Property for proposed work: �� 1�'/ /�,�/l i�tGi e� c f / <br />n <br />(Street Number— Street Name—City—Zip Code) <br />Name of Property Owner(s): ,�ij ��i//!i/GLd� (_� O/n �Y�/I//� P Phone <br />Address of Property Owner(s): 111(P <br />(Street Number— Street Name—City—Zip Code) t <br />Name of Contractor(s): lz/, Ilol laol Phone #: �> Z <br />Contract Company Name: <br />Address of Contract Company: // /,5^ s X 12 i`d ,'1lq <br />,[ (Street Number—Street Name—City—Zip. Code) <br />Current Use of Building: <br />(Single Family—Multi-Family—Commercial—Government—Industrial—Vacant—etc.) <br />Type of Building Construction: l& --..e <br />(Wood Frame=Brick—Stone tee'—Concrete—Other) <br />Proposed Work: kIn-Vnd ❑Landscape ❑New Replacement not in-kind) ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: +5�,�-� .7 '7 X116 <br />t - <br />Owner/Contractor Fax #: e-mail: Gam/ <br />(Staff will re o ith o* one designee) -------- <br />and/or X <br />re of O� er Si�f�re of Cont actor <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />