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227 West Jefferson Blvd., Suite 1400S | Ph: 574-235-9371 | Fx: 574-235-9021 | hpcsbsjc@southbendin.gov <br />Description of Proposed Work Please provide a brief detailed summary of the scope of work to be performed. <br />Signatures <br />Signature of Property Owner Date <br />By signing this application, I agree to abide by all local regulations related to project and to obtain all applicable Building Permits.