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2. Date
3. Permit Number
5. Job Name*
6. Job Address*
8. Contractor*
9. Phone Number
11. Fax Number
12. Address
14. City, State, Zip
15. Description

    Note: If Deferred Submittal results in changes to the original plans, it will be considered a Revision and additional Revision fees will be applied.

17. Contact Person*
18. Contact Phone Number*
20. Email
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22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field