13-67-001PROVIDE MUNICIPAL PROCESS NUMBER HERE
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Contractor No. jr,
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New Construction on Demolish
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Vacant Land Addition Attached
Alteration Interior Addition Detached
Description of Work
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Sq. Ft. Units Floors
Repair
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Repair Due to Fire
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Chg. Contractor
Owner
Category
Re-issue
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Revision
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Last four (4) digits of
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Owner's Social Security No.
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Name
6.
Address
City Xpj�e
2 State Zip
Phone
Wli,
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2 Cr
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Name
Address
City —State _ Zip
Phone
frst hour and
$65 per each addition hour in addtioa to the review fees. Minimum charge one-hour.
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review fees m3y apply.
15'
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