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2. BS&A Web Pin Request

4. BS&A Web User Name*
6. First Name*
7. Last Name*
9. Company Name (as it appears on your license or any dba)*
11. Address1*
13. City*
14. State*
15. Zip*
17. Phone*
18. Email*
20. Contractor License Number (if applicable)
22. I will be submitting the following permit types (check all that apply)*

    1. Building Permit
    2. Electrical Permit
    3. Plumbing Permit
    4. Mechanical Permit
    5. Zoning Application

    1. E911 Permit
    2. Entrance Permit
    3. Work in the Right-of-Way
    4. PZE Process (Zoning Case Application)
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24. 1. Receive an email copy of this form.
25. Email address

    This field is not part of the form submission.

26. Submit

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