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LC. Name of Applicant Signature of Applicant bio iby | Lackeannte, AN oe pif ss of U albhr m7 Applicant Phone No. hor vay i Ovhr Applfcant’s ca cor Role of Applicant to Project (owner, attorney, lessee, agent, architect, engineer, contractor...) _ Pepe Owner: Address:bi b, b. Ll lan, Wine wee Director of Development