Laserfiche WebLink
L� <br />• <br />JUL 27 201$ Mh <br />RW <br />HISTORIC PRESERVATION COMMISSION <br />OF SOUTH BEND AND ST. JOSEPH COUNTY <br />County --City Building, South Bend, IN 46601 <br />http://www. southbendin.gov/govel•nment/department/community-investment <br />Phone: 574/235.9371 Fax: 574/235.9021 <br />Email: hpesbsjc@southbendin bov <br />A Certified Local Government of the National Park Service Elicia Feasel, Historic Preservation <br />Administrator <br />APPLICATION FOR A — CERTIFICATE OF APPROPRIATENESS <br />OFFICE USE ONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY <br />Date Received: 7/-"7/2-0('s" Application Number: $603 — 67Z7 <br />Past Reviews: YES (Date of Last Review) 1 i 71 ;1 2 ❑ NO <br />Staff Approval authorized by: Title: <br />Historic Preservation Commission Review Date: lu <br />Q <br />❑ Local Landmark Local Historic District (Name) 0,6"A A <br />❑ National Landmark National Register District (Nance) bw;e- <br />Certificate <br />ACertificate Of App ro riateness: <br />u Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and issued: <br />Address of Property for proposed work: <br />Name of Property Owner(s): <br />Address of Property Owner(s): <br />(Street Number—Street Name—City—Zip) <br />Phone #: <br />(Stye t Number—Street Name—City—Zip) <br />• ... E <br />Name of Contractor(s): Phone #: 13 13:5. 1 <br />Contractor Company Name: Tae C t_q e <br />Address of Contractor Company: �' as tr fn I- T 1G <br />(S •e t Number—.Street Name—City—Zip) <br />Current Use of Building: C6 { fA fA t <br />(Single Family—Multi-Family—Commercial—Government—Industrial—Vacant—etc.) <br />Type of Building Construction: <br />Proposed Work: (more than one <br />box may be checked) <br />(Ii7ood Frame—Brick Stone—Steel—Concrete—Other) <br />❑ Landscape ❑ New Replacement (not in-kind) ❑ Demolition <br />Description of Proposed Work: ll OOL LI tic ✓ P vtyad 1 t\C i adl ,- J ErCxi' dtool°_ <br />Owner e-mail: <br />X <br />Signature of Owner <br />and/or Contractor e-mail: __-- <br />and/or X t-�-� <br />Signature of Contractor <br />By signing this application I agree to abide by all local regulations related to project and to obtain a Building Department Permit, if applicable. <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE— <br />