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i <br /> PERMIT NO. <br /> RESIDENTIAL/AG PLAN CHECK PROCESS: THE FOLLOWING ITEMS MUST BE COLLECTED <br /> BEFORE ISSUING THE BUILDING PERMIT:C <br /> Referred to Fire District: � <br /> Balance Due: <br /> District: Date: Fees Valid Through: <br /> Date Retumed: <br /> Signature of Owner or Contractor <br /> Corrections: <br /> Owner/Builder Form <br /> 1st — Date: J'c 7 <br /> Notified h G XTP(V. , Proof of Ownership <br /> Date Returned: <br /> Contractor's License No.: <br /> 2nd — Date: Expiration Date: <br /> Notified: <br /> Date Returned: Workmen's Comp Insurance Certificate <br /> I Expiration Date: <br /> 3rd — Date: <br /> \ I Notified: SJAFCA <br /> Date Returned: D D� <br /> $Cho01 Certificate i <br /> Date: Status: <br /> Will Serve <br /> eRgefp,� <br /> From: -=6 D n <br /> Signed Special Inspection Agreement <br /> Floor Plan for Assessor <br /> Public Works Release Form <br /> [� Other: <br /> APPROVAL STAMP: ! 11 � Other: <br /> Gypmvaf of pl=ns shill nit �a consmict9 to be <br /> permit fief cr ar. appx—.c Gf P.yr V;t) ir7i1 of any <br /> PERMIT APPROVED: <br /> seCUen at SAX �y n county�6des a brd-mn�S I <br /> l\XI Date: Applicant Notified: <br /> S-q1---u <br /> Date (, <br /> SAV)0AQUIN COUNTY BUILDING INSPEG=DEFT <br /> I <br /> PLAN LOCATION'"�'� <br /> DATE I REMARKS <br /> r <br /> I <br /> i <br /> BPAPPSIBPFILE2.TF(3/97) <br />