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,. � - <br /> , <br /> �� ; _ �\. <br /> ENGINEER OF RECORD CONTACT INFORMATION <br /> Firm Name: Check One: ❑ Corporation <br /> (as it appeazs on license) ❑ Partnership <br /> ❑ Sole Prop. <br /> Contact Person: <br /> Address: <br /> Phone: Fax: <br /> Email: <br /> If firm is a sole proprietor or partnership: <br /> Owner(s) of Company <br /> Engineer License Number: <br /> Date Fum Was Founded: <br /> Under Laws of What State: <br /> vayeuwx <br /> Y " , ^y <br />