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00 <br />MmMl q#0#41 <br />opp1 •. tog; .....C'rr....R11 ,gg, O <br />PublicOF f ............TT <br />.... <br />EVERETT BUILDING DEPT. korks fRfw <br />'Dept. <br />Date: `+lid i 9 1 <br />To: Ben Edwards, Plans Examiner <br />Re: Owner's Name: F of tl1 Ro d 5 — <br />Project Address: a 1 0 :z 5+- fe S1-- <br />Attached are the Repair Specifications for the above mentioned <br />project. Please provide CHIP the following information by <br />initialing the proper box: <br />YES NO <br />11 <br />Plan Check Required: ❑ 7 <br />y �( <br />Please return this form to CHIP as soon as possible. <br />Thank you. <br />CHIP Staff <br />