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CHIP <br /> � � � ;� CITI' OF E�'ER[Ti' <br /> � � COtiiMUNIT�" F[OL.�SING [MPROVEMENT PROGkL�.�[ <br /> 10: Plans Examiner, Building Department <br /> From: ��— G���7i�[1_—, CHIP Staff <br /> Date: _�/��6 <br /> RE: ��/r4 ��CZ/A�SK/ Owner's Name <br /> �Gb$ /G , Project Address <br /> Attacheci are the Repair Specifications for the above mentioned project. Please provide <br /> CHIP the following information by initialing the proper box. <br /> Yes No <br /> �lan cher,k required: <br /> 7� <br /> ❑ � �/�g/�� <br /> Please return this form to C as,soon as possible. <br /> / <br /> Thank you. <br /> �� <br /> CITI' OF EV6RGTT <br /> ?��±0 \�'eunore A�enue. Suiic Illll • E�erett. �VA 9ti'_01-�10�1�i <br /> 1'_06t3�9-37;i . Fa� l'_0613i9-4626 <br />