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City of South Bend <br />and St. JoSeph County <br />HISTORIC PRESERVATION COMMISSION <br />Sarah Andrews, <br />President <br />A Certified Local Government of the National Park Service <br />www.southbendin.gov/hpc <br />227 West Jefferson Blvd., Suite 1400S | Ph: 574-235-9371 | Fx: 574-235-9021 | hpcsbsjc@southbendin.gov <br />Certificate of Appropriateness Application <br />Property Address for Proposed Work <br />Street Number Street Name <br />City Zip Code Parcel ID (Office use only) <br />Primary Property Owner(s) <br />Name <br />Address (if different than above) <br />Contractors to be used <br />Company Area of Work (ex: roof, windows, landscaping) <br />Name Phone # E-mail <br />Company Area of Work (ex: roof, windows, landscaping) <br />Name Phone # E-mail <br />Company Area of Work (ex: roof, windows, landscaping) <br />Name Phone # E-mail <br />Continued on back → <br />Ross Van Overberghe <br />Historic Preservation <br />Administrator <br />May 17, 2024 MA Rec. 261481 $20.00