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Sarah Andrews, <br />President <br />MAY 0 2 2024 m Pk <br />Rac .0 Lo» L4 73 <br />CITY OF SOUTH BEND <br />AND ST. JOSEPH COUNTY <br />HISTORIC PRESERVATION COS/ MISSION <br />A Certified Local Government of the National Park Service <br />www.southbendin.gov/hpc <br />Ross Van Overberghe <br />Historic Preservation <br />Administrator <br />Certificate of Appropriateness Application <br />Property Address for Proposed Wor <br />/4(16 Ph re <br />Street 3e b <br />117Th <br />?Xfl(I <br />Primary Property Owner(s) <br />1115 <br /> <br />/1; <br />Zip Code Parcel ID (Office use only) <br />Address (if different than above) <br />Contractors to be used <br />--1-:/3 <br />Company <br />Name <br />Area of Work (ex: roof, windows, landscaping) <br />Phone # E-mail <br />Company <br />Area of Work (ex: roof, windows, landscaping) <br />Name <br />Phone # E-mail <br />Company Area of Work (ex: roof, windows. landscaping) <br />Name <br />Phone # E-mail <br />Continued on back + <br />227 West Jefferson Blvd.. Suite 1400S <br />Ph: 574-235-9371 I Fx: 574-235-9021 hpcsbsjc@southbendin.gov <br />