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FOR CITY USE Validate received:Fee Paid: $150.00Receipt #:Received by:City of South Bend
1102 W First St.
PO Box 9
South Bend, WA 98586
Phone: (360) 8755571
Fax: (360) 8754009
www.southbendwa.govPermit Number:RIGHT OF WAY PERMIT APPLICATIONAPPLICANT INFORMATIONAPPLICANTS NAME:COMPANY:
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