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Fire Department Impairment Notification
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Impairment Address or Parcel Number
Assessor's Parcel Number (APN) of the property with impairment:
Please provide a description of the impairment and expected duration (Be as specific and complete as possible):
If known, please provide the name of the responsible person(i.e. tenant, property owner, etc.):
Please provide a description of the impairment (Be as specific and complete as possible):
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