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APPL7C\TION : =2 UJ.7L'R(a[O;A.'J 7; -IK R�ZROc IT• OR FIP'aG UPAIR PETnIT <br />73ZS 2'E.— =X?=N-CS 90 DAYS F --cm T} A?PROv„_y� 1,0HOZ �t:L IOr 1n S <br />ARIAS- I m-.c;k:E PERP -IT TrPE 1 -ID -4: <br />_.-'A•S'K 2= O: IT PIPZ-NC RETAIR <br />;_',A S iT=- 3 i 7f20..'ECT COATI'AC'I 1 7 <br />7 <br />.E?S 6 <br />/� �® 209 461-6337 <br />c=aGILI=Y Y= t o OC6 PHONE E-7� r <br />zAJDRESi (?C(113 <br />L t CROSS SI'TZEE:' <br />L.(..-( p.l I PHONE 2 i <br />ELITE IV CONTRACTORS, INC. s , <br />o• 209 462-6337 I <br />z ! cowrRncrnx aDREss 2535 WIGWAM DRIVE ca Lxc 2 66001 6 <br />'r ' 1 — A,C, 1 0,11AZ 1 <br />R( fisvRF� ) •tDRx_cnnP_2 <br />046-008761 <br />T fi i <br />of <br />PHONE ; ! <br />�fi:f�ae:zfa a}r4[et[fs[a et of a.f, y PHONE 2 J <br />J!}SE [16806[[[[Aet[[[[[}t EE■}[ <br />l9 -. Ti"1-YY iD A - d <br />1 T__\_ SIZE Q—TCA*-5: T/P2—EtDATE iff I'Arrrn ' <br />TJ <br />! � f <br />! i <br />I11?eIfIfill fill lfIIilllitllltlllflllIIIIII3IIIII Hill IfiIIIZiff-III fill <br />IiHIIIIIIifitlll[IIIIiiiillllti[iIIIIIIIitltIllitii� <br />a <br />. ( APPQOv'D V APPROvFM W=H MKDI-_,ON(S) DISAP_RovED . <br />V I nAX REVX ®/ :Sc"'E ATTACIISEVr 'lzinC J I <br />vArtE <br />119v i <br />__Ai1111III fill III Iill 1111th.I111111IIIi1lilt III IIIIIIIIIIfIIiIIIIIIII;II II IIIIItIII1iIIIiiIiItIIIIIIItIIitIIIII1iIIiIIIIII[II1111,— <br />T1US-• 2E7RFORH ALL WORX' :X ACGCRDAvcs ST';g -11 <br />.L?2LI�TY _JOMWIN Y 02JZ<ANrET_ SUITE LAWS. lnD 2DLES atm 2B:U ATIOKS OF i <br />SaN JOAQUrN CnKJWX-X ?"B1 -XC HEAL -3 Sc"72v3C=S_ C:.l OR LUTNSED AGD4•S S;:GZMTJRE <br />I�QfORtSAc�C= of T`L£ :CORK FO? j]IZCFJ TRIS ?=�-SZT ZS ZtQrz�n �`ZiIFIFS Z}lE EOI+DWZNG= -Z (MR1-•FY ZXA? _V i <br />Z S)XL --I Dimor AMY P_-vS;0 c IN SL.6 A KAWRER AS70aLConE- ! <br />5:19.TFCT' 'IO ctJF:.:G -S cOrcP�cSA2IQ. ZASLS of QS_=_zaxx1_- CMCrRACTOXS UXZ-� OR S—CoNrSth Ti2+� SIG�a=VRE CE[TZLZ£S TaE <br />LKi IFY TY.= Lit 1Ti£ F'£R 'vCE OF -_ME: vGZ-. AOR WBXQI THIS PJ'bgj' IS L.SSUID EOLIAerIS .! <br />�rSP2t>ATIOx - AWS 0-I" <br />CAL-c ,>;._� - L SHALL FtJPLOY P`�SONa SU37ECT _U vORlKfit•S - I <br />- -- - rI•rL '""'DATE _ <br />stdicaze the responsible party to be billed for additional PAS -Em staff time expendedbevond <br />:a: ->,e -mit payment 0k <br />coverage .per to _ If the party deligrated below is different expel the pe -nn -it nd <br />.aiDplicaat, e=9- property owner, ZTe party Insist acknowledge this -responsibility for the billing <br />�v signatmLe and date below. <br />Hanle address pi�Ie numbez <br />-:s; =5nature_ <br />C H 23-0038 <br />