Fillable Consent to Undertake Proposed Work IDENTIFICATION Site Location (The State of New Jersey)

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Consent to Undertake Proposed Work IDENTIFICATION Site Location (The State of New Jersey)

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OWNER
AGENT
U.C.C. F101-CUPW (10/2014)
SIGNED:
OWNER/AGENT
I, the Owner Authorized Agent of the Owner, of the above property hereby
consent to the entry onto the property of the Builder/Contractor, and the employees
or agents of the Builder/Contractor, for the purpose of correcting violations of the
New Jersey Uniform Construction Code.
Further, I consent to the work to be done as described in the attached proposal of
the builder, subject to compliance with the Uniform Construction Code as deter-
mined by the local enforcement agency.
IDENTIFICATION
Permit #
*
Consent to Undertake
Proposed Work
Date Issued
Builder
Site Location
Block
Lot
Qualification Code
Owner in Fee
Tel.
( )
Federal Employee No.
Address
Address
License No.
( )
Tel.
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Consent to Undertake Proposed Work IDENTIFICATION Site Location (The State of New Jersey)

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Completed 13 April 2021

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