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Description of Work a We Const Type
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# Stories #Units (if Res)i
Remodel SF Valuation $
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APPLICANT'S NAME Last eE�Gl�rw
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ARCHITECT/DESIGNER'S NAME Last
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Architect/Designer's Address Architect/Designer's E-mail Address
City State F Zip��— Telephone-
ENGINEER'S NAME Last �p "�Ij First L' .iN
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CONTRACTOR'S NAME/COMPANY Lic. No. Classlrr
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SETBACKS REAR SETBACKS FRONT IT NO. I,d zoft
SETBACKS LEFT SETBACKS RIGHTiv'" n t•>. 1 �*
_ PLAN CHECK NO.
USE ZONE DEVELOPMENT N PLAN CHECK FEES $