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Building Grading
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Description of Work
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# Stories #Units (if Res)
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Valuation $
New/Add SFF
Remodel SFF Garage/New/Add 7
Material/Labor0 �I
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OWNER'S NAME
Last PoSC( First
Owner's Address
Owner's E-mail Address
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City
State F Zip [7-7-777 Telephone[ —
APPLICANT'S NAME
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Last .i OS� First I CO I ( il" 5
Applicant's Address
Applicant's E-mail Address
City
State � Zip F_ Telephoner
ARCHITECT/DESIGNER'S NAME Last First —Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F Zip F Telephoned
ENGINEER'S NAME
Last F First Lic. NoF—
Engineer's Address
Engineer's E-mail Address
City F®
State Zip ! Telephoned
CONTRACTOR'S NAME/COMPANY y y) i 5 -i 0
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Contractor's Address
Contractors E-mail Address
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City CQYYIfi0S
State L� Zip Telephone
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1U265
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SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. (c2Ai-101y
USE ZONE
DEVELOPMENT PLAN CHECK FEES $