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�HIP` <br />� !� �- � i �: "� c, � l <br />ae , +� � „ Cffl' (11= 1:�'ERI:TT <br />'`�r �Q � �"' COtit�IUNITI' HOIJSING I�IPROVL-�-IENT PROGR:\�1 <br />To <br />From: <br />Date <br />RE <br />����a <br />Plans Examiner, Building Department �� <br />�AN � <br />� f 1011 <br />„�.�, t;��,/f�ih-, CHIP s��Ll� woRks <br />Tr // <br />IntC:'�'�n�ctr, ri ���r� r'. Owner's Naine <br />3`��l• ,,1' <br />Project Address <br />Attached are lhe Repair Specificaticns for Ihe above mentioned pro�ect P!ease �rovide <br />CHIP the following information by initi�ling the proper box <br />Plan check required: <br />Yes <br />� <br />Please return this form to CHIP as soen as possible. <br />Thank you <br />No <br />-a <br />t lll t�l 1:\I.RI.I l <br />,.�� A1."i,,,�r: A�znur. �uit:• ��'i� • �`��ir�!. A1�A'��'��I-.f�_l� <br />, _ -'_�-.. ��.n � 1'� � _:-_�r�'ti <br />