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10/17/2011 14:45 2094640195 CAL !)JATER PAGE F1'2/03 <br /> ,'Pwrj'PL-FC• _l;F.'1f 21 a"D—R, Z'I+k{rL'L4_li.!�L�1i:�'1�t'-.''��4",Z <br /> 'o <br /> Of 4 i `12 <br /> ^Wj <br /> PORMS <br /> BUTS <br /> v. (city, 91batraa .Zip Cade) <br /> (,Dsem CDd8 Talaphons member), <br /> . 5l�c�t� dbet�iled plaxa� ��y sraba�.tted) . ; <br /> alae '[�aadersigaad here-by.applies for pex .ssiOn tD.e�:eavat coa.struct 'and/or <br /> c�tl�es��cat3eesa�xoaeh on -�D=t—V-- y I ight-bf-Wmy•or�-4ahe _IIlLA x�_. .d�.. +f <br /> approximately _ 11 0 [ saat Jmil m OY'+b <br /> of S S'.ri _ , b=r va�soxz its the <br /> follmo i mg work (dascri ptian of.work) : <br /> work will commence on or ab t 1 for aiaproximatlely <br /> lad <br /> the =A6-rSjgaec3. cextify tit an the cv .er of the xesgea'tive pxaperty, or am <br /> qna�ifi(--d to =&present.the O=mi. a•vd agree to do the. -work des cri)�ed ehotre in , <br /> acccz-dance with the rules, regvlationo'os Sa'a ao�-qu�a Co=t y a=d svbj eet to <br /> inspectiox► a3ad appxova]. <br /> Io 1) <br /> Sigxaat<sre cf �.pplica�.v - �i ® • <br />