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CITY OF SOUTH BEND <br />AND ST. JOSEPH COUNTY <br />HISTORIC PRESERVATION COMMISSION <br />Sarah Andrews, <br />President <br />A Certi fi ed Local Government of the Nati onal Park Service <br />www.southbendin.gov/hpc <br />227 West Jeff erson Blvd., Suite 1400S | Ph: 574-235-9371 | Fx: 574-235-9021 | hpcsbsjc@southbendin.gov <br />Certi fi cate of Appropriateness Applicati on <br />Property Address for Proposed Work <br />Street Number Street Name <br />City Zip Code Parcel ID (Offi ce use only) <br />Primary Property Owner(s) <br />Name <br />Address (if diff erent 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 />Conti nued on back → <br />Ross Van Overberghe <br />Historic Preservati on <br />Administrator <br />July 2, 2024 MA Rec. 626107 $20.00