HomeMy WebLinkAbout626 Linden St - Applications/Shed - 01/17/2003Last First
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Street Address Please Specify: LN. DR. CR. WY. PL. ST CT RD. AVE.
Cl/t�y State Zip Code
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Company Name
License Number
Supervisor & Cert. #
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Mailing Address
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37556 Lee Lake Ave.`}
State Zip Code
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Phone
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Please Specify. LN. DR. CR.
WY PL. ST CT. RD. AVE.
Zip Code
JOB SITE ADDRESS ��.�..
Subdivision/PUD
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Filing Number Lot
Block
Lot Area
Building Square Fop ge
Number of Stories
Building Height
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Number of Bedrooms/Bathrooms
Finished Basement Square Footage
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Value of Construction (including labor, material, profit)
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Description of Work:
Subcontractors:
Electrical Mechanical Plumbing
Roofing Concrete Framer
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I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all
requirements contained herein and city ordinances and state laws regulating building construction.
Signature 12.4
Print Name L� i <�cg �,.j je �P S Phone�a
Distribution: Original — L & P Yellow — Office
THIS APPLICATION EXPIRES 180 DAYS FROM APPLICATION DATE