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• <br />• <br />MAY 0 7 2018 <br />HISTORIC PRESERVATION COMMISSION gee ND <br />OF SOUTH BEND AND ST. JOSEPH COUNTY <br />Count) City Building, South Bend, IN 46601 <br />http://www.soudibendin.gov/govemment/department/community-investment <br />Phone: 574/235.9371 Fax: 574/235.9021, <br />Email: hpcsbsjc@southbendin.gov <br />MA (qAq fay. <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 ONLY»»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY <br />Date Received: ``d Application Number: 2L 14) — 0606 <br />Past Reviews: YES (Date of Last Review) ❑ NO <br />Staff Approval authorized by: <br />Historic Preservation ommission Review Date: <br />L Local Landmark <br />❑ National Landmark <br />Certificate Of App ro rlateness: <br />f Denied ❑ Tabled <br />Title: <br />❑ Local Historic District (Name) _ <br />❑ National Register District (Name) <br />❑ Sent To Committee ❑ Approved and issued: <br />Address of Property for proposed work: tc If'VE l R V'Ac1 kcac( �DU` 1 Banca Ti(.,i z*64 9 <br />(Street Number—Street Name—City—Zip) <br />Name of Property Owner(s):7h0ma3, �cendg',:�AaA i Phone #: 7q –q5 of – 84,16 <br />Address of Property Owner(s):o`iS$ C')ev1Z(av)dl RJ- 'cerci% >C� <br />(Street Number—Street Name—City—Zip) <br />Name of Contractor(s): (�n5 � ru.c h oyl Phone #: . �Q.O % �' �� 149" <br />Contractor Company Name: <br />Address of Contractor Company: o y y�b S. Vyo� Cott' / l lie.. 1 i\ LA(079s <br />(Street Number --Street Name—City-Zip) <br />Current Use of Building: O)D bArrg^1 \ou 11 11 F13- UV er CA COLA '% �" ekcx 1 t'�-"Vt%)o %S . <br />(Single Family—Multi Family--Commercial—Government—Industrial—1 <br />Type of Building Construction Pole. -ut 1C)l n <br />ood Fi•ame—Brick—Stone—Steel—Concrete—Other) <br />Proposed Work: ❑In -Kind ❑ Landscape D9 New ❑ Replacement (not in-kind) <br />(more than one box may be checked) <br />Description of Proposed Work: ��� �O� r ATI VWL u V\A WL)171% SVkC>OV) <br />�,� C�.tc ncespza-Fv. N!�� hof�� S�a.tly 'lz�tt �sr�ucin, 4�rtnQrS�s. 1`GsevrR �l�; <br />❑ Demolition <br />i C WZ j f 1Nt� • -10Wer i v 'o 10r, 11 a hex <br />•Ownere-mail: J �t` re 5g1(e ' (a? q tract r 1 r GJVt and/or Contractor e-mail: Gi er5 e ('ye e en, ',1 . Corn <br />Xand/or X <br />Signature of Owner 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 />A ""T IrdN A TTd%WT A TT T TCITTT\ AAT CT71T <br />