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/ Residential NOT;EA FEES DUE AT TIME OF SUBMITTAL
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Description of Work
Use F—Const Type
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"16 FALL CA44 P�
# Stories[— # Units (if Res)['
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Valuation $
Material/Labor t a�+
New/Add SF F_
Remodel SFr— — Garage/New/Add
OWNER'S NAME
Last I LAVAEC First �(0uj5A-
Owner's Address
Owner's E-mail Address
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City /PrW.&,er-
44.d State r� Q_ Zip [ Telephone
APPLICANT'S NAME
Last Q�f�11MS First
Applicant's Address
Applicant's E-mail Address
23 i2 ��zi�
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City r(^
State I %Q. Zip C2_ Telephone �Cca 1 T -y
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ARCHITECT/DESIGNER'S NAME Last/a ,_� Firslx Lic. No. -- - -
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Architect/Designer's Address
Architect/Desi 's E-mail Address
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city V ylck
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�� 1 State Zip � J elephone
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ENGINEER'S NAME
Last Lj j�� First Lic. No: �
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Engineer's Address
Engineer's E-mail Address'P
12-6) l ,,- 'T11) -T)111 /6Z -
City AH01 M
FA
StateFC Zip �i 2(r(j� Telephone �14 �2Q _�JUU
CONTRACTOR'S NAME/COMPANY /V IC6 1 C+S (� Lic. No. Q [/q/pro Class
v D% 0
Contractor's Address
Coo�ntractor'ss E�-mail?/Address
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City TVs7/ ,l
State �%/j� Zip �j 2 1S�2 Telephon€ q
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SETBACKS REAR
SETBACKS FRONT PERMITNO. 0
SETBACKS LEFT
SETBACKS RIG U10tin PLAN CHECK No.` ,, 4i
USE ZONE
DEVELOPMENT Nliftw,PLAN CHECK FEES $,, S1,�w3