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C. CERTIFICATION IN LIEU OF OATH A. …

DESCRIPTION OF WORK: I hereby certify that I am the (agent of) owner of record and am authorized to make this application and perform the work listed on this application. Applicant sign/Contractor sign and seal here: Print name here: [ ] Licensed Electrical Contractor [ ] Exempt Applicant D.TECHNICAL SITE DATA QTY.

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  Electrical, Technical, Descriptions

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