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CITY RESIDENTIAL ROOFING PERMIT APPLICATION <br />ST.JOSEPH COUNTY CITY OF SOUTH BEND BUILDING DEPARTMENT <br />PROPOSED <br />PROJECT ADDRESS: 533 River Ave. South Bend <br />Address City Zip Township <br />46601-3235 <br />PAYMENT: <br />CHECK # <br />CARD ❑ <br />CASH ❑ <br />PROPERTY OWNER: Eugene Joseph Cieplinski <br /> <br /> <br /> <br /> <br />*SIGNED CONTRACT SHOWING COST OF CONSTRUCTION MUST BE PROVIDED UPON APPLICATION SUBMITTAL* <br />COST OF CONSTRUCTION: TEAR-OFF/RE-ROOF: $ 17,437.63 OR OVERLAY: $ <br />INCLUDES SOFFIT/FASCIA: YES ❑ NO MI <br />BUILDING CONTRACTOR: ASSCHER ROOFING COMPANY OR OWNER AS CONTRACTOR ❑ <br />PHONE: <br />ADDRESS: <br />574 234 9380 <br />EMAIL: asscherroofing.com <br />1130 W.Western AVE. South Bend IN 46619 <br />Address City State Zip <br />*AII contractors must be registered with our department. For more information onthisgo to <br />http:llwww.south bendin.govlgovernmenticontenticontractor-licenses-0 <br />*Application can be emailed to us at building@southbendin.gov or provided to the address below for review. <br />*Application must be signed below. <br />I certifythe above to be atrueand accuratetothe best of my knowledge. <br />APPLICANT SIGNATURE <br />7/19/2024 <br />DATE <br />PRINT NAME ORG/BUSINESS OR OWNER <br />574 210 3745 renato@asscherrofing.com <br />PHONE EMAIL <br />EXCELLENCE ACCOUNTABILITY INNOVATION INCLUSION EMPOWERMENT <br />125 S. Lafayette Blvd. Suite 100 South Bend, Indiana 46601 p 574.235.9554 f 574.235.5541 I www.southbendin.gov <br />