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1984, 05-12 Permit App: 00000208 Plumbing Fixturesr rn W CC X LL0 CC W 2 Z PLUMBING PERMIT APPLICATION WORKSHEET PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND 1 Owner's (Last) (First) (M) 1 v Department Use Only Project No. G.C.t ►i710.,� 2 Project Addr ( t Mailing Address) Space Zip /!, ii 13 v;til 3 City/Community I State Subdivision/ Plat Name 4 Assessor Parcel No. I Lot Block 16 factor Firm me k (�� } j L Street Address L� 17 ZipCity E/ I cJ ,,,k,, oC; :��.i State it Lo _ one_ :