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Application <br />- FOR - <br />Certificate icate o f Appropriateness <br />Historic Preservation Commission of South Bend & St Joseph County <br />125 S. Lafayette Blvd., South Bend, Indiana 46601 <br />Mailing Address: County -City Building, South Bend, Indiana 46601 <br />Phone: 574 -235 -9798 • Fax: 574-235 -9578 • Email: SBSJCHPC®co st josephan.us <br />Website: http: / /www.s§osephcounVMdianarnm /s chp /index.html <br />OFFICE USE ONLY » »» DO NOT COMPLETE ANY ENTRIES CONTAINED IN 7WS Bt -X » »» OFFICE USE ONLY <br />Date Received 00 Application Number a <br />Past Reviews: [ YES (Date of Last Review) oW NO <br />Staff Approval authorized by: <br />Title: <br />Historic Commission Review Date: / &Z .ZUD <br />❑ Local Landmark Yrocal Historic District (Name) <br />❑ National Landmark ❑ National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied ❑ Tabled ❑ Sent To Committee ❑ Approved and Issued <br />DATE <br />Address of Property for proposed work: L'733 E . W0,Ynt , So v &n d, z N . 4 <br />Street Number and Street Name <br />Name of Property Owner(s): (Please Print) Dan! C1 I& kr lA jNS,� . r <br />Address of Property Owner(s): 1 '7 3 3 E. W wyAt 50Ur h a Im <br />Contractor(s) Name: Pella 10 r►doU4 <br />Contract Company Name: Pel1a► 6)1 <br />Contractor Address: 12%G E - U n t v ersi Nn, 1>1 i v e. <br />City : er 3:jj . 4 Phone ( 674) 2 <br />Current Use of Building: S i Vicle Fqe na (v <br />(Single Family — Multi - Family — Commercial — Government — Industrial — Vacant — etc.) <br />Type of Building Construction: w bod frn <br />(Wood Frame — Brick — Stone — Steel — Concrete — Other) <br />Proposed Work- ❑ In -kind ❑ Landscape j o New �R Replacement (not in -kind) ❑ Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: Reolqu 2 dnw uc4rn las si 4 <br />Wig M eat tYs�ri►,_� ;�;er�#.� aS CID& +5 C ar i.lgA <br />Con rUt av% Qd Px4j . All 4 w' amix -Far_, Wa ne <br />Owner /Contractor: Fax: ( 574) 2S2 — - 2 8 er e -mail <br />(This of fuse will eorrespmut urith only one designee) <br />and /or <br />— APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />