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S}.i.C'1"(()N 5 S�,M1'L,I:: PEtC)J}:;;C'1' t�'(7I2C�SF(E�,I:�;.C. <br /> Prepared by: Contractor Name: <br /> Date: Contractor Phone Number: <br /> Description Code Exterior Residential Other Tenant Professional Total <br /> of Work Permanent Finish Fees** <br /> TOTAL $ $ $ $ $ $ $ <br /> TOTAL $ $ $ $ NOT $ $ <br /> ELIGIBLE ELIGIBLE <br /> ** If the applicant is performing the labor, professional estimates for the work must be <br /> sought and submitted. Applicant's labor fees that exceed these professional estimates are <br /> ineligible expenses. <br /> 9 � �' {' i-y <br />