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0 <br />Appi cauon <br />-FOR- <br />t61 0` <br />cawficate, ofApproplateness <br />HISTORIC PRESERVATION COMNUMON Ds ary <br />,ofSOUfH FEM & Sr. JOSEPH COIWff <br />125 S.tdqyeftBlvd, SuWhB=d, IN 46601 <br />http-Jtwww4osepheoii[itykdima.CDM/depmtmmtsWCHPrm&mhtm <br />p: 574-235-9798 E 574-235-9578 e: SBSICHPC@coslrjosq*.!.us <br />OMW VSECMr,>->m>D0N(YrC0MPIM ANY ENTRM CUNTAWWINTIWB0X-C<<<<<0FMCff USE OMY <br />Date Received: Tme 2. 301:7 AppucafiaaNmnbw. 3-017 060) <br />YES WIM-OfLM&'w Rofb n NO <br />staffAmrova numorized by. Tide: <br />rutalit'Prummuflun Conn fuslau Review IDat4- IA VAL 0 %-1 <br />LocdL=dM2* <br />n <br />nNaYionallsndmask 0 <br />Cerfficaft orAppropflatme= <br />nDenied ❑ Tabled n SeetToCon umWee nApproved and issued: <br />(Mm pfino <br />Addrbm of Property for proposed work: -M. r <br />(SYfte f Aimb er-- Sftet K= e— Code) <br />Nphone k g/; q -- 3 40,9- <br />meofFrop <br />erty Owner(s): Elf <br />Address Of prope'ay OMU(S).. <br />(Mreet Number—Sbvef]Vme-Ctty—� Code) <br />Name of Cantmetor(s): 461(c 1-dZ.Wc+ Phone #-. <br />ContractCompuyName: A5;.Vj <br />Address of Cortct 1ptqnpmuy., <br />Current Use of Budding: <br />Type ofBandfag Canstructlanz <br />qo 0, <br />(SWvet Number— Shvef Name--afr—MW Code) <br />p-mgk Family—Muni Family—Co mmvvkd--Government--Indo&kd--Vacmd---eta) <br />Proposed Work n Yu -Mud <br />(more than one box may be checked? <br />Desa#fiouofProposed Work <br />-owner/Contmctor Fax#: t -mail: t�,OVJ A6 <br />andfor. <br />Sigmature,6f0mar z-ofCoirtrador <br />—ATWI Yr-AqMnV JDI?inTTFDVWgVWM AVIV I IM -Mn n-aUVUVDCV Cyn -V <br />