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Associated Building Permit # J� ire Sprinkler F Fire Alarm F_ Fire Misc
1.. Project Address (Not mailing address) Floor Suite No
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Tenant Name # Units -
2. Description of Work
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Extg Sq Ft-- New/Added Sq Ft �� Total Sq Ft �l00
Valuation $ I� 6",
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F_ New F_ Add F✓Alter F_ Demo
# Stories
r 5. Engineer's Name
Last �— First F_ Lic. No. �.... ---
Check Appropriate Box for Applicant/Notification
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3. Owner's Name
Last i� First
Owner's Address
Owner's E-mail Address
City
StateZip
�— F— Telephoner
F 4. Architect/Designer's Name Last F First F Lic. No.
Architect/Designer's Address
Architect/Designees E-mail Address
City (- W
State r� Zip'— Telephone—
r 5. Engineer's Name
Last �— First F_ Lic. No. �.... ---
Engineer's Address
Engineer's E-mail Address
City
State �— Zip Telephone
/� Contractor's Name Last )&. vIS&V-\ CeV0-FrS First(.-...---.._ Lic. No. 1 %04(7 Class[(/O/,-/6
Contractor's Address/
Contractor's E-mail Address
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City SG,n{��-e S�f, y5
State CA Zip 670 Telephon
OFFICE USE ONLY
PERMIT NO.
TYPE OF CONSTRUCTION
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PLAN CHECK NO. C
OCCUPANCY- GROUP
PLAN CHECK FEE $e I-��