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n1 <br />RQC. co 2(, l l q Ste- CV <br />CITY OF SOUTH BEND <br />G � <br />AND ST. JOSEPH COUNTY <br />HISTORIC PRESERVATION COUI/ISSION <br />Sarah Andrews, <br />President <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 />R .' - - <br />Street Number Street Name <br />uA-k 1-4e,,4 966,01- 3.23 5— <br />City Zip Code Parcel ID (Office use only) <br />Primary Property Owner(s) <br />Ft) vne.- �5 ' 1� �,c . 1 i r� s i <br /> <br />Address (if different than above) <br />Contractors to be used <br />- 5 1�� � r �►' C'r�- Tee- r-, <br />Company Area of Work (ex: roof, windows, landscaping) <br />E-mail <br />Name Phone # <br />Company Area of Work (ex: roof, windows, landscaping) <br />Nome <br />Phone # E-mail <br />Company Area of Work (ex: roof, windows, landscaping) <br />Name <br />Phone # E-mail <br />Continued on bock + <br />227 West Jefferson Blvd., Suite 1400S I Ph: 574-235-9371 1 Fx: 574-235-9021 1 hpcsbsjc@southbendin.gov <br />