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- 4 NOTE. PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 11GV {/� f y
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Description of Work
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APPLICANT'S NAME Last �. I— J�
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ARCHITECT/DESIGNER'S NAME77-777
Last _ _ First
Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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Stt ate Zlps—i Telephone
ENGINEER'S 14AME Last —�
First .�— J� Lic. No.L��:��
Engineer's Address Engineer's E-mail Address
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CONTRACTOR'S NAME/COMPANY nn /
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ACKS REAR SETBACKS FRONT PERMIT NO.
LEFT SETBACKS RIGHT PLAN CHECK NO.ONE DEVELOPMENT NO ->P)
PLAN CHECK FEES $ T