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.4, <br />Application <br />-FOR - <br />Certificate of 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 josephinus <br />Website:http://www.stjosephcoungindiana.com/sjchp/hidex.htn l <br />OFFICE USE ONLY »»» DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX »»» OFFICE USE ONLY <br />Date Received G lLl <br />l oZ� g Application Number (/' d - 0 TO 6 .4 <br />Past Reviews: n YES (Date of tit Reoiew) <br />• <br />Staff Approval authorized by: Title: <br />Historic Commission Review Date: 020 a20a <br />❑ Local Landmark [;�Loeal Historic District (Name) .. <br />National Landmark National Register District (Name) <br />Certificate of Appropriateness: <br />❑ Denied [] Tabled ❑ Sent To Committee E] Approved and Issued <br />DATE <br />Address of Property for proposed work: 1733 E , W&Yne , Sb V--4 8th Q i zv. cf 6,6 L5I Street Number and Street Name <br />Name of Property Owner(s): (Please Print) D' A41 w4si; ht WQ'+CAr N <br />Address of Property Owner(s): 17 3 3 Wa�he So A ,R..odi- ?N, `+66 IS <br />Contractor(s) Name: Poll& ,e <br />Contract Company Name: Pella► w;s <br />Contractor Address: 1226 E. Vn firer s l lr, Pr ive <br />City: Crr"jer T&U. cF 653,6 Phone: (57 �) 2U7- 355-7 <br />Current Use of Building: -SMq le Fpm 1. iy <br />v / <br />(Single Family - Multi -Family - Commercial - Government - Industrial - Vacant - etc.) <br />Type of Building Construction: l,/a o A r <br />(Wood Frame - Brick - Stone - Steel - Concrete - Other) <br />Proposed Work: t4 In-kind E] Landscape New r-1 Replacement (not in-kind) E] Demolition <br />(more than one box may be checked) <br />Description of Proposed Work: Arr 2 A0W, tAjT A d 2 v»,i nn n,aS N+;+4 <br />wlofe uq; e41C i�—+,.i " 94A,s as civic ,Fe fli+i d�wr l den Sirvc-Fran N r7/J� .tl �i/�C . <br />All 1v1- whdnr.R,t 91 xr <br />113 n im be re Luo, <br />Owner/Contractor: Fax: 5 7 4) 2$ 2- 7 264 e-mail <br />(This office unTl correspond with only one designee) <br />and/or <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE — <br />