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K:\General\Edits to Website REQUESTS\Engineering\Request for fax permit service BEST.doc CITY OF EL CERRITO PUBLIC WORKS DEPT. 10890 San Pablo Avenue El Cerrito, CA 94530 Ph: [PHONE REDACTED] Fax: [PHONE REDACTED] Request for Fax Engineering Permit Service (clearly print or type ) Contractor/ Company Name Street address City Zip Code Phone No. Fax No. Contractor License No. Expiration Date El Cerrito Business Number Expiration Date The undersigned give the City of El Cerrito Public Works Department permission to accept a facsimile of my signature on a faxed permit application in lieu of my original in-person signature at your office. I hereby certify that I will comply with any and all declarations and agreements on the faxed permit application that bear my signature. The following people have my permission to use my credit card to obtain fax permits in the name of my company: Name (print or type) Signature Contractor’s name Charge card: VISA MasterCard (circle one) Account No. date: