Laserfiche WebLink
Application <br />-FOR- <br />Certificate <br />FOR- <br />Certi icate ofAppropriateness <br />Appropriateness <br />- - a' HISTORIC PRESERVATION COMMISSION 0 <br />x 1865 R of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Blvd., South Bend, M 46601 <br />http://www.stj osepheountyindiana.com/departments/SJCHP/l*ndex.htm <br />p: 574-235-9798 £ 574-235-9578 e: SBSJCHPC@co.st-joseph.in.us <br />OFFICE USE ONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED 1N THIS BOX«« OFFICE USE ONLY <br />i (� n _ <br />Date Received: -1 1110 Application Number: Vu 10 —A U 9 <br />I Past Reviews: tf ITS (Date of Last Review) ❑ NO e <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: AA,(&A ti hil D <br />dLocal Landmark ❑ Local Historic District (Naxre) <br />i ❑ National Landmark ❑ National Register District (Nance) <br />Certificate of Appropriateness: <br />❑ Denied ❑Tabled ❑Sent To Committee ❑Approved and issued: <br />(Please Print) <br />Address of Property for proposed work: <br />(Street Number= Street Name—City—Zip Code) <br />Name of Property Owner(s): G ' L�� W • 1,5,-Y-2 <br />Phone#: elm— 70 V— <br />Address of Property Owner(s): 1 �� ° l' . t <1a -,,j i�,/. �p,Y/< d,—/_ <br />(Street Number— Street Name—City—Zip Code) <br />Name of Contractor(s): �F r� ��r� Phone #: 5a i&�e <br />Contract Company Name: 5r� <br />Address of Contract Company: 12-r-10 W, ! Grorv.C,j Vi • �'.Vz <br />(Street Number—Street Name—City—Zip Code) <br />Current Use of Building: <br />(Single Farnily—Mzdti-Fantily—Corrirnercial—Government—Industrial—Vacant—etc) <br />Type of Building Construction: If,"_ K <br />(Wood Franie Brick--StoneSteel—Concrete—Other) <br />Proposed Work: ❑ In -Kind ❑ Landscape ❑ New Replacement (not in-kind) ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: 120, <br />LHwi(1/•dtiS lJBGly� +f ELS ��vJ /`'�^t�-JSar.-- C� �+ /`�P �ISG� innvti�pt� �IEGG �e+G", <br />Li NG �� Gal / � 1/sri-'d� S r C-/tn.r /JrOWr` • . <br />Owner/Contractor Fax #: e-mail: e'a+" <br />(Staff will correspond with only o e designee) / <br />X ' c and/or X <br />Signature of Owner Signature of Contractor <br />—APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />