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OWNER'S NAME
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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ARCHITECT/DESIGNER'S NAME
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CONTRACTOR'S NAME/COMPANY
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SETBACKS REAR SETBACKS FRONT J7 i 2 7Q q
PERMIT NO. /� i� l t'
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO,.
USEZONE DEVELOPMENT NO
PLAN CHECK FEES $
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