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OWNER'S NAME
Owner's Address
Remodel SFF � Garage/New/Add �—
Last
First �—
Owner's E-mail Address
City
State —
Zip
APPLICANT'S NAME
Last
Applicant's Address
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City State �-
ARCHITECT/DESIGNER'S NAME
Last
ArchitecUDesigner's Address
City
State
ENGINEER'S NAME Last
Engineer's Address
First
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# Stories[— # Units (if Res)
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Applicant's E-mail Address -
Zip �— Telephone—
First
_ Lic. No. F�
Architect/Designer's E-mail Address
Zip C TelephoneF
First Lic. No.
Engineer's E-mail Address
City
State Zip F Telephoner
TRACTOR'S NAME/COMPANY
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/! Contractor's E-mail Address R -r&2 vsb'b 6
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Zip 27Z _ Telephone ?/ `'5�7 233
SETBACKS REAR SETBACKS FRONT '22 -LO
l PERMIT N0.
SETBACKS LEFT SETBACKS RIGHT
USE ZONE PLAN CHECK NO. 2 I -I I , -um
DEVELOPMENT N�
/� PLAN CHECK FEES $