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BU'IL01NO PBRMIT APPLiCATION, <br /> }� SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 981.0 E..HAZELTON AVENUE;,STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)488.3129 <br /> a ' IN6P9CTION RILQQ EST-24 HOUR)tECORDSRr(209)408.3105 <br /> THC'A..... AT1GN M,UST UE COMpLATE LY F1Pli W QUT; kY TkiE APPLICANT IN CRDL iT APPt „FOJt 3 <br /> [3u D <br /> BcopefsflNoitt CCa^$d �wC1 : n q yr@�.} i�t,ittOia 5 ht .ldl+� on an f' i�s+- x3A�e;o1 <br /> Project Address: r2ao% N. bcc, Z-a.,o ASL. 5 tpLltov; _ .CA 0(5245 <br /> Project Valuation: Contact E-Mail! <br /> ®WNf 1 NNCJ[U AN4 ADf?R ` 777777777 <br /> S ? Rl'LIPAIIT,IVAl11E AND'/�6PRH3�' <br /> Name:(>vnccal- Pec-(brmavtoe -TffveE +t am-5tLC Name: (�liCho�Q�y dct�Cto� d <br /> Addrass:'�)0155 W,. /N-!l Address.30 ,5 Lo. <br /> city:S+. Jotiv, state: Mj Glty:0, t . Sbvkv,6 statez to T --- -- <br /> ZIP: 1-18lilq Phm-Avo %-Lq-L'fII-1 ZIP: $ jq Ph#(4'd9)1-'z"I- gII-k <br /> .. t3ANTRIi TQR:1)lKbRIV)/1TIQ(I ,. Ph#( <br /> Lic. No: Company Name: <br /> Address: City: Si: ZIP: <br /> ,�O�31Q4J6RIN�t)RMATIC)N '• Ph#(�r� ��i�j-'7-O'3-1 _ <br /> Lie. No: tan a$ Company Name: <br /> Address; alt( rQa s; e QiCQ, Sk;�e loo City: 54tck+., Sr. CA ZIP: q5-Z <br /> Ph#( <br /> Company Name: <br /> Address: City:- St. ZIP: <br /> Permit WIII be Issued to an"Owner-Builder" 'Yes El No <br /> 01 101 .V ONLY <br /> If yes,a oomplated Owner Builder Verification Form must Identification Number: <br /> be a! nod and submItted along with copy of the owner's <br /> idont rioatlon prior to lasug%or,of the building permit. <br /> DEOLAF2ATIt 1N BY•GONSTRUCT.ION Pfi'NV APPUIGANT <br /> B m signature below, I cern to one of th <br /> By y g certify a following: <br /> I am❑a Califbrnia Ildonsed contraotor or:(a the property owner or L]authorized to aot on the property owner's <br /> bahalf(requires wr)ttan approval and Ownerif3ulldor Verification Porm signed and submitted). <br /> I have read this construction permit application and the Information I have provided is correct, <br /> I agree tocomply with allapplr blo county ordinances.and state laws relating to building construction. I authorize <br /> representatives of this city or anti o enteri Hdentifla operty for Inspection purposes. <br /> Applicant's Signaturef LL Date: <br /> For your ooilvenlohbe chobkilsts dotai(Ing any add ltt al suismittal requlromonts for var a bus ding parmit typas <br /> :aro svallable.at the quildfng'Division countore Dotttt lttfon permit and mobile home on f0un00000'requlro ohook- <br /> list. <br /> rMlipllcallon Forms&HandoutMHANDOUT8001ding Permlt Ap01100110n.40sPage t of 2 <br /> (Revised(67-69.16) <br />