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<br />PLUP�^RING
<br />�II NF.NnL CONTRIICTOP MAIL A�DRE55 PHONf LICFNS[ NO.
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<br />n1! i'r�nNICAL CONTR4GTOR MATL ADURESS PHONE LICENSE NO.
<br />�'i uM111NG CONTPACTOR M41L �UDNE55 .. .--- ---"-- Iq�•inl
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<br />�O114 C<1PILSI �
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<br />i rrt _.__ nlocK __ t,l NO. TVPE Oi EOUIPMENT FEE
<br />�� �_-��—�- —�--�� --�-- Al1�CUN11 UNII!i IIY IA S 1
<br />�i:�'��.� Z�� fa�CC�on♦d) ii��r�i,iu�,ii,r�,nv�is ��v i� - �--�--
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<br />� � iY' u . ��.' `. : _ .._.. _'" '— _ _ •__y— -
<br />y .� "'u� hFATERS BTU M
<br />PI.UM8ING
<br />NO. � 7VPE OF FI%TURE ON ITEM
<br />WAIEHCIU:CI_ITpll.11� ---_
<br />IIAIHlUII
<br />InV��111HVIlYA!:11_HA:JNI �-------
<br />5��nwln _'_- -_.'_
<br />.v�1�:��iPo`u��v.P.DISP.' �—
<br />�Ui �,rlWn!L�Fn _ --- -
<br />,InUNUPVTPAY
<br />ji'1 oTM[S WASHER
<br />�wn-FnG�enrFn _ __. _
<br />�UIIINpL
<br />�UII'NKWG!')UNl/�IN
<br />� � I..IUfV SINK un [�qAIN '_
<br />IVnCUUM OHEnKFRS —_
<br />HO(t� ONniN; 11nINLE40ERS
<br />�si�rdr`iseravicE nnrv �rc.� ---
<br />� I ��.: �,i�nRA7 W E CUOLERS
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<br />FEE ,,:����nNDLINGUNIT- QF.M.
<br />S 1 .��i�:l fIMOq
<br />I ��. . .. .__ .
<br />SVfl TOTAL
<br />. _ '_—____" _. _
<br />VERMIT S
<br />_—_—. . __. _—_— __ __ _._ . - _' — . _
<br />._____'_'__ _ IOTn�fFf �
<br />SIpEYqHOtiE1L'ACK S1PI�EISf
<br />UPL I.U1�[---�--_ l01 4RF�
<br />� �'9 � 4 CONST OCCt/PAN(
<br />!atl. nr -I�LUG. � NO. UF ST(
<br />I lflf 2ONF �-'�- � IIA!�'-111'll
<br />SI'� G111 CONIII I ION9
<br />SVB
<br />I
<br />— 7
<br />—!
<br />TOTAL FtE T __�
<br />i in�, i�� i1MIT OECOMES NULL ANO VOIp IF WORK OF CONS��ni�'
<br />ii��y r,i�i��OF12E0 i5 NOT COMMFNCkD'NItNIN 170 DAVS Oq if
<br />�'��':'[� nUCTION OR WpqK IS SUSPLNpEn OR ApANDONED FOR l�
<br />�'ll'iul��nl I?ODAYS�I4NV Iib11 AfTERWORKiSCOMMENC[��.
<br />i��L i+!!�� ftRT�F V T1111T 1 HAyE PE11D AN[) EXAMINED llll: ��
<br />�'I �� nl u�N �Np Y,NUW TME S�MF T(� fiE TRUF 4NIl CORRF.C1 ALL
<br />�'N�n'it:mN: Of �qWg pNU OR[�IIJANCfS GOVERNINfi TH6 IVPF.
<br />iil IpIHY. Wi� � OF COh1P� IFf1 WIT11 WHETNER SPFCIfIH1 11[RFIN
<br />��i� nini ir�e aAnatirvu ur n vei+n+n noes Nur Praesirr,�e r�,
<br />iuvl ..�iI�InRiIY Tp VIOI A7E UP CANCEL iME PROViS�c�NS flf
<br />:.r:r (11�IfN eT4TE OR I.00AL LAW qE0U1.ATiNGCONti�ilUf iiJn�
<br />��i' lu[ P[PfpqM�NGE OF CONSTHUCTIOh
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<br />i � �niU�(tCOf CObT1�nfTOHI�Rn�itli nGFNT ATE � -
<br />1H�(:K HE�R Vpn�� ., ii :,i r� i,�r� CHFCK NUMPtN PI �N CH6CK FEE
<br />!! F tiECE1PT NO
<br />_... . ._ - rJ�C�NI',iii
<br />1
<br />❑vEs .'jr:�� FEE& I VAlUAT10N-_ �"—�FE[
<br />V GROUP NO.Oi� OWI � i i•r, __--'- - .. _— . "—'..�
<br />UNItS I
<br />I
<br />� "—_ _. - '.__ 1
<br />MA%.OrC. i��.-.I� 1�1��1I�Irv�� � 5 �i�c'rw � � I..�
<br />d I J��V �7
<br />'--___ _ ...._ __'
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<br />^1 lihtlLNO �
<br />1 Iqf.SPqlfl111 H•I �
<br />PI UIIIHLU ..—. "' "�—�
<br />nu t'nA�UCAI � i
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<br />. __ ._ _ " ..___—'.____ -
<br />_ _" 1'1 I:1 I Iv __—" _. - . . '
<br />tC .IUJIo� I
<br />� 1
<br />TOTAL �l I..�
<br />liJ
<br />PffiMIT VAl IDATION
<br />_— .����„i,��,ii�...:i�n�,��i. ��� � .�
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