09676 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY
BUILDING PROJECT I DENTI FICATION7 PERMIT NUMBER
BUILOING APPLICATION & PERMIT
ApDIMS09670
BUILDING-ELECTRICAL-PLUMBING-MECHANICAL
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NAME 1' OTY. ELECTRIC PERMIT FEE
I'I \ PHONE _::�_ 1
CONTRACTOR SOUTI: