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• <br />• <br />HISTORIC PRESERVATION COMMISSION <br />OF SOUTH BEND AND ST. JOSEPH COUNTY <br />County�ity Building, South Bend, IN 46601 <br />http://www.southbendin.gov/goveniment/depariment/community-investment <br />Phone: 574/235.9371 Fax: 574/235.9021 <br />Email: hpcsbsjc@southbendin.gov <br />Timothy S. Klusczinski, President 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 ONLYS»»>DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY <br />Date Received: 0(o 0 ?-Ol s Application Number: — <br />Past Reviews: n YES (Date ojLast Review) ❑ NO <br />Staff Approval authorized by: <br />Historic Preservation Commission Review Date: <br />❑ Local Landmark <br />❑ National Landmark <br />Certificate Of Appropriateness: <br />R Denied ❑ Tabled <br />Title: <br />Local Historic District (Name) �, 1 P r L- <br />National Register District (Name), :,n "•. 1'��' `- <br />❑ Sent To Committee ❑ Approved and issued: <br />Address of Property for proposed work: (q o c ��<-k A V P, &7 —& r� , <br />(Street Number—Street Name—City Zip) <br />Name of Property Owner(s): - IL a (�- )-\-a C r r Sven Phone #: <br />Address of Property Owner(s): (0 O <br />Name of Contractor(s): �So w, r�-� cl.O t CN Phone #: B % 4 - -&O AS--�17a-7 <br />Contractor Company Name: Uce_n 6�"-u_ �tnn c�r��j res r h <br />Address of Contractor Company: a N O <br />Current Use of Building: <br />(Single <br />YYl 0'r rs i YAC k-�6 ye- <br />(StreetNumber—Stre Name—City—Zip) <br />'scant—etc) <br />Type of Building Construction: -Ct' C. rv-sX— <br />(Wood Frame Brick-StoneSteel--Concrete—Other) <br />Proposed Work: (more than one ❑ Landscape ❑ New o eplacement (not in-kind) ❑ Demolition <br />box may be checked) <br />Description of Proposed Work: SA -v- CIS AAq-(+sT1"4.gyNi <br />�C{�.Cs�` �� S <br />.Owner a -mail: '50SA �,1"i ani—) q-0 / andkor Contractor s -mail: 61 a.LA y�Cxxpv- J- G dl) -(Om <br />X and/or X <br />Signature of Owner snatfifeof 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 />� rrr rir � mi��T i.r�>•rrrsr+s.-r.�rmn � �+ra �' TL'mTT AI.T TT�TT.1T [tT nrr. i. <br />