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Sarah Andrews <br />President <br />MAR 0 3 2026 m n <br />Rte,. u ty ,C1, Ec)_0 co <br />CITY OF SOUTH BEND <br />AND ST. JOSEPH COUNTY <br />HISTORIC PRESERVATION COMMISSION <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 />.2_ I <br />Street Number <br />soi,?' A-6-d <br />Cty <br />Primary Property Owner(s) <br />Name <br />AVC <br />Street Name <br />Zip Code Parcel ID (Office use only) <br />(:; <br /> <br /> <br /> (if different than above) <br />Contractors to be used <br />WiJ(/4Cc' <br />Company <br />Name <br />/00 <br />LAC <br />7 ' - ZST- g c‘ <br />Phone # <br />. r��D /%e' s0,r/1-r4 <br />Area of Work (ex: roof, windows, landscaping) <br />ov,}r/rr u�;�i,� <br />E-mail <br />Company <br />Area of Work (ex: roof, windows, landscaping) <br />Name <br />Phone # E-mail <br />Company <br />Area of Work (ex: roof, windows, landscaping) <br />Name <br />Phone # E-mail <br />Continued on bock + <br />215 S. Dr. Martin Luther King Jr. Blvd. Ph: 574-235-9371 1 hpcsbsjc@southbendin.gov <br />