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Name <br />Sarah Andrews, <br />President <br />MAY 0 2 2024 mf <br />Rec. a6)14ri2. 5-20.vp <br />CITY OF SOUTH BEND <br />AND ST. JOSEPH COUNTY <br />HISTORIC PRESERVATION COvNISSION <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 Work <br />/ 3 /.2 l -•.e s � <br />Street Number <br />)44,74/71 <br />City <br />Primary Property Owner(s) <br />Street Name <br />Zip Code <br />Parcel ID (Office use only) <br />A /4'eee/0 �. s # 5/ mom/ <br /> <br />Address (if different than above) <br />Contractors to be used <br />M / C/I / 9/f Cot c/'Cc c7/i <br />Company <br /> <br /> <br /> <br />Company 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 Ph: 574-235-9371 Fx: 574-235-9021 hpcsbsjc@southbendin.gov <br />