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XO
Date:
Plan #
Permit tbs L l is"
Building Permit Application
(Complete pj highlighted areas)
Property Address:
Property Owner (please print):
phone
Mailing Address: (if different than property address)
C]Ra (OWNER) (CONTRACrOk) ge (AUrH0,R1zEziAEPREsENrArivE) of (owNER) (coNTRAcro.R)
kKIM NAME:
SIGNATU DATE:
PUBLIC WORKS COMMENTS: OCCUPANCY:
Reviewer
FIRE DEPARTMENT:: 0 approved w/ comments 0 disapproved El no review required �� Bldg Valuation: $,