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Application <br />-FOR- <br />Certificate of Appropr ateness <br />HISTORIC PRESERVATION COMMISSION <br />of SOUTH BEND & ST. JOSEPH COUNTY <br />125 S. Lafayette Bled., South Bend, INI 46601 <br />http://%�ti«v.stjosephcountyind iana.com/departments/SJCHP/index. htm <br />p: 574-235-9798 f: 574-235-9578 e: SBSJCHPC@co.st-joseph.in.us <br />OFFICE )USE ONL 1'»»»DO N OT COMPLETE ANY ENTRIES CONTAINED i V THIS BO`C<««<OFFIL'E VSE ONLY <br />Date Received: _/ LZ 1-7 Application Number: <br />Past Reviews: YES (Da(eojtasrRvic-) ❑ NO <br />Staff Approval authorized by: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark <br />❑ National Landmark <br />Title: <br />dLocal Historic District {Name) . PkAt <br />❑ National Register Districtrti'cme) <br />Certificate of Appropriateness: <br />❑ Denied ❑ 'fabled ❑ Sent To Committee ❑ Approved and issued: <br />(Please Print)0 ` G L &� av, j Av ���I t �w (0Address of Property for proposed iiork: t �7 /] <br />j 1 (Street Number— Street Name--City—Zip Code)) <br />lame of Property Oiv'ner(s):_jj1�i a n Phone #: 7i `� �P • �i%'i . <br />Address of Property Oivner(s): SClh1rt tL 6A AD, VI? <br />(Street Number— Street 14ame—City—Zip Code) <br />lameofContractor(s): Prue'o- at.tS+-aA1g01V1 Phone#: 57q. ?.",Sy. 3jt7r <br />Contract Company Name: /V1't�`e-S+b1� �t,p L.f'.0 . L. -LC <br />Address of Contract Company: 1 � � /,�,7or l� t 4It.P.t l 'f-tl �6Q) <br />(Street(Number— treet Name—City—Zip Code) <br />Current Use of Building: () iVl� ` B�,Yl�tt I <br />(SingI Famfly-Multi-Family-4ommercial—Government—Industrial--Vacant—etc.) <br />Type of Building Construction:�►f'tv"v `� -r ,e Q__� _-_,iro 1.4 4 A kacL (%Gt-4�'C4 <br />iVood FrameBrick—Stone—Steel—Concrete— ther) <br />Proposed Work: ❑ In -Kind ❑ Landscape zvew ❑ Replacement (not in-kind) ❑ Demolition <br />(more than one box may he checked) <br />Descri tion of Proposed Work, l'.i7_ G 4""fT ,L t d.2 <br />Owner/Contractor Fax #: 5-7 q. 2sq_ 3 k o q e-mail: _6�� t ' o- <br />(Staff ivill correspond %rith only one designee) <br />X and/or X <br />Signature of Signature of Contractor <br />--APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />