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,_,,; ,rt,�,�;, ��I"1'1. O1� �<)[ �"1'1-i 1�►i�:\I) <br />' HISTORIC PRESERVATION COMMISSION <br />S.v.r, Andrew, A Certified Loral Governmect of the Natioral Palk serviceRoss Van Over berghe <br />Cer-hfieare of ArproprOtenc Contr,-ictor Release Form. <br />I, the property owner(s), grant the below -mentioned contractor or company permission <br />to submit this application for a Certificate of Appropriateness on my behalf. I certify that <br />I understand and am aware of all the proposed works included on this application. <br />—Property Address for Proposed Work <br />833 <br />South Bend <br />Primary Property Owncr(s) <br />Tom Scrace <br />Ashland Avenue <br />46616 <br /> <br />05/16/2025 <br />Contractor Applying for COA <br />Horner Roofing & Siding LLC <br />Samantha Evans - Poject Manager 574-318-0316 samantha@hornerroofing.com <br />05/16/2025 <br />