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The Applicant for the Building Permit in compliance with Act 44 of 1993 hereby submits II. If a Certificate of Insurance or Self-Insurance has been submitted please complete the following Name of Insurer or Self-Insurer City State Policy No Zip Code Coverage Period Ends Name of Contractor/Policyholder Contractor/Policyholder s Federal/State Employer Identification Number EIN 1. 2. The Insurer has been notified that the municipality issuing the Building Permit is to be named a policy...
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How to fill out 100 gettysburg pike
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