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APPLICANT'S NAME
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ARCHITECT/DESIGNER'S NAME,Last _
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CONTRACTOR'S NAME/COMPANY Lic. No. ESQ b Class
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SETBACKS REAR
SETBACKS FRONT PERMIT N0. 7V "3
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
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DEVELOPMENT NO 1�11tp1 PLAN CHECK FEES $ I 1 5
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