Get the free I hereby certify that I am the (agent of) owner of
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Date Received
Control #BUILDING SUBCODEDate Issued
Permit #TECHNICAL SECTION
A. IDENTIFICATIONAPPLICANT: COMPLETE ALL APPLICABLE INFORMATION. WHEN CHANGING
CONTRACTORS, NOTIFY THIS OFFICE. CALL UTILITY
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I hereby certify that is a statement or declaration made by an individual confirming the truth and accuracy of information provided.
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The purpose of i hereby certify that is to ensure that the information provided is truthful and accurate.
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