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f <br /> f <br /> BUILDING PERMIT APPLICATION <br /> f <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 181.0 E. HAZELTON AVENUE,STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)468.3121 <br /> F" <br /> g4coR`' INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165. <br /> f <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BYTHEAPPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: /(/&V 5'CA fT <br /> ProjeetAddress: 'Z /f�16,1 s' e1A_p6 ) <br /> Project Valuation:��6�0� 000 Contact E-mail• g�ynaa k hatle <br /> dam! !i5 <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> -Name: j/ C. r ff58G Name: 5E l/ rA7d'iZ.C. <br /> Address- _ jO 4j cf-1ve E, c7,- Address: . Z I Ca /i✓o i6 (, <br /> City 3?dG��d/i State: C City-2de Id i State: 7� ry ' <br /> ZIP: �S 2 S Ph#(,ZOP ''[i --73dv ZIP:& z.C9 Ph#(2 ) MJ -Von <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No Company Name: <br /> Address City: St ZIP: <br /> c^ <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic.No:- Company Name: phwo J• A&4/0-0 17l) f- 9�! 6161 J ' <br /> Address: '310 City: ,S'/,/jVV)ezd St ZIP: GJZ�lf L <br /> LENDING AGENCY Ph##(V R ei 9 <br /> Company Name: <br /> (address: City: St ZIP: <br /> �Permltwillbe:issued'to an"Owner Builder' YesNo❑ OFFICIAL USE ONLY <br /> Jf yes a completed OVm6r-,BuilderVedficati on Form must Identification Number: <br /> beigne end submttfed along with dopy of.the owners <br /> iddtsfifitidh prjortosuance of the;building permit. <br /> EQLARATIONBYCONSTRUCTIONPERMITAPPLICANT <br /> ��_ ., e o e of a following <br /> dm a a t isC or[]the property,owner or❑authorized to act on the-property owner's <br /> betf(r <br /> Y �� S�+werlButk�et•Vertficatton'Fonnsrgned and submitted)_ <br /> l hhye thnS�J - 190 ¢hd(fifprmahon (aYe provided is correct, <br /> t agrto complytrt e b trdnahces and sfate laws relating to building construction. I authorize <br /> sepissenNattvds b �ntth danhfierl property for inspection purposes_ <br /> l <br /> Applicants Slonature- r bate <br /> FForyour convenience checklists detailing any additional submittal requirements for various building permit types <br /> are available at the Building Division counter. 6eiriolition permit and mobile home on foundation require check- <br /> list. <br /> r <br /> R:Applimtion Forms$Han6outs\HANDDUTSIBuilding Permit Applimtmdocpage f of <br /> (Revised(07-0&10) <br />