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Es: Zoning District: Value of Work Permit Fee The undersigned hereby applies for a permit to the following work, which will be done in accordance with the description, plans, building and zoning specifications submitted, and such special conditions as may be indicated on the permit, and pursuant to all Federal, State and Local Law, Rules and Regulations. Phone No. OWNER: ADDRESS: TAX MAP: SEC BLK TYPE OF OCCUPANCY LOT Size of Property NATURE OF PROPOSED WORK One-Family Dwelling Two-Family.

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