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Work e t for Combo Building & Solar Permit Application
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL S=%
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Description of Work
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Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last First F Lic. No.
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ENGINEER'S NAME Last _ First I Lic. No. 0`11
Engineer's Address Engineer's E-mail Address 77�'
City ( _ - State �— Zip I Telephoned.
CONTRACTOR'S NAME/COMPANY ✓r 4-,, (2A r y -e f / Lic. No. 3W& 9C Class /3
Contractor's Address Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT OWV)PERMIT NO. 0:3 1+'Zd L
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SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT N PLAN CHECK FEES $