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CI-�IP � . <br />^�'rm� � ee c'ITl' OF E'.1'I:KI' I f <br />`� �� r� ��� C0111�1L;NIT�' li()l'Slti(; I�1PR0�'F.�tENT PROGRA�1 <br />To <br />From <br />Date <br />Plans Exammer, Bwlding Department <br />�(? � �t/J� __ CHIP Staff <br />� ~J!�-a�2— - <br />RE �RAi�ST ��ARSf�R.4 N-� �Sbl� _ Owner's Name <br />5�5� F_ •��e�t�l ST _ Fro�ect Address <br />,�_'L�����s ��I <br />���� <br />1U�d 2 �J � f�, �, - . <br />i �.�-; ;i, t i <br />� ,�,�, �,�,. r• <br />Attached are the Repair Specifications for the above mentioned pro�ect Please provide <br />CHIP the foliowing mformation by initialing the proper box. <br />Plan check required <br />Yes <br />� <br />Please retum this form to C P as soon as possible <br />� <br />Thankyou � ` � <br />�C�c., � <br />v /. <br />I� <br />� II1 i�I I\I f:l ll <br />'�� �,�. A1r�iw�i� A�r iur. tiuile ��ln • I:�rlcli. A1 V �h'ill--lU.l-1 <br />� ,i.. �-:5 I�.i� iJ'?� �?' Sh'\ <br />