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CITY OF ALANTIC BEACH
ROOFING PERMIT APPLICATION
Owner(s) :
Address: LA (0 _S R)C�"�' ?tf, P_6 -Phone:
Lot # Block or Unit # Subdivision:
Contractor: f-Y) f_1%C_ V\C�
Address :
City, State and Zip --x Phone 22 -0 C) Q)
State License # Q C-
Describe work to be performed: C. CC, f
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Valuation of Proposed Construction: "Yo U, Q
Materials to be used:
Signature of Owner;
Signature of Contractor:.
Liability Insurance Supplied
Workers Compensation Insurance Supplied
License Information-