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Lansing, MI 48909 Print 517-241-9328 www.michigan.gov/bcc 139 Clear Agency Use Only This form can be completed by tabbing to each field and typing in the required information. Authority: Penalty: 1972 PA 230 Part 11 Premanufactured Unit Rules, Rule 1172 Failure to provide information may result in denial of your request. INITIAL APPLICATION ANNUAL RENEWAL LARA is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upo.
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