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i <br /> I��TICE <br /> c�crc�t AND INSPECTION REPURT <br /> � Q� - --- <br /> Ow'nrr_ _�'�1�-'.{t. L/��. � � <br /> -�.._'_cl_`'K."_____ <br /> Address cf bui;d:n9/_`��/�- ,�� � <br />, __-_ ___ �__ —_'_._ <br /> �nniraCtor_'___ <br />� TYPE OF INSPECTION REQUESTED <br /> I <br /> ❑ ELDG: Pmf. Nn. _ Cj MECH: FmL No.________ <br /> r ❑ ELEC: Pmt. Plo. _ y1�7'pLg- Pm�. Na. ' - <br /> �//� . S_7s <br />. ❑ Fofing � frcming / <br />� 0 Foundalion ❑ Br�r.ch Circuif <br /> ❑ Drywoil Nciling � Furnccc <br /> ❑ Concrete S!ab �'1�'-uph-In ❑ Fin�l <br /> ❑ Fireplcce ond Chimnry / [� 5������ <br />� - _ ❑ Other__._. _ . <br /> APPROVAL -__ - - <br /> - <br />