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NOTE: PLAN CHECK FEES DUE AT TIME 0
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Project Address (Not mailing address) F_ Flood [ Fire [ Liq [Landslide [N/A Floor Suite No
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ascription of Work Use C- Co stType'
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1 �e.� _j� r I#� ---- ------ -- Valuation $
Remodel SF Garage/New/Add C Material/Labor
New/Add SF� _ LL
OWNER'S NAME Last �' -- First
owner's Address Owner's E-mail Address
ZEE-r r'�j �L -- -- - - -- - --
City - — —_ State & Zip i (��C� Telephoner
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APPLICANT'S NAME Last — — —_ First
Applicant's Address Applicant's E-mail Address
City State Zip �— Telephone
ARCHITEC --- Last First �/U, L� rI h l Lic. No.
Architect/Designees Address Architect/Designer's E-mail Address
State Zip e-7Z6z�,® Telephone
City UTT57-7-
ENGINEER'S NAME La $f L i — First
d Lic. No.F ,
._
' Engineer's E-mail Address
Engineer's Address
City
State Zip F Telephoner
Lic. No. �— Class
CONTRACTOR'S NAME/COMPANY'- - —
Contractor's E-mail Address
Contractors Address
State
city
Zip �— Telephone
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SETBACKS FRONT PERMIT NO.
riSE
S REAR PLAN CHECK N0.
S LEFT
SETBACKS RIGHT
E DEVELOPMENT NOPLAN CHECK FEES $