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2. Building Permit Number: *
3. Company (Builder) Name:
5. Contact Person:*
6. Email Address(es):*
8. Current Mailing Address:
10. City:
11. State:
12. Zip:
14. Phone Number:*
15. Notes:

    (Gate code, location description, etc.)

17. Subdivision Name:
18. Lot Number:
20. Road that Driveway Accesses:*
21. Road that Structure Faces:
Leave This Blank:


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