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HomeMy WebLinkAboutX2021-1768 - Permit Application_' / - - 14 ^^^ i.,. State R_4�V^{ V"1(.a-i�'I�V I � lV ��V,r •/ �� Zi Tele PP '�g�7 ,hone T77 UtH, ARCHITECT/DESIGNER'S NAME Last-- First Lit. No [ Architect/Designer's Address Architect/Designer's E-mail Address City State i Zip' J Telephone GI ENGINEER'S NAME Last �- First Lic. No. Engineer's Address Engineer's E-mail Address City State Zip Telephoned CONTRACTOR'S NAME/COMPANY Lit. No. Class nt . '. P\ Contractor's Address Contractor's E-mail Address �J City nr—. i _C f r�� �[ OUR t r ry7J "fir State r� Zip /�/-7-715 1 ��! �elephone r�> — ^% l) t SETBACKS REAR SETBACKS FRONT. �/ rI( PERMIT NO.h �Z 17G a SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. USE ZONE DEVELOPMENT NO PLAN CHECK FEES $