Laserfiche WebLink
BUILDING PERMIT APPLICATION <br /> - <br /> VI ll <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> BUSINESS PHONE: (209) 468-3121 <br /> INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR <br /> BUILDING PERMITS. <br /> Scope of Work: V,570// S ' �j <br /> Project Address: lr4#1 rCl72 <br /> Project Valuation: Contact E-mail: '^Ucrt/ ✓t_ �—�1 J/ y '�� <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> Name: nre-,L- Name: 1,&r7- <br /> Address: �? /j gjy fj rd Address: 4cw st4 drl allcl <br /> City: STPOE71PAJ I State: 014• City: SAIJA I State: l d <br /> ZIP: 957,1 Z- Ph#�7in ) -3X'bg` I ZIP: Ph%9 ) ,�'/�-,J/ <br /> CONTRACTOR INFORMATION I Ph#( ) <br /> Lic.No: Company Name: QJ e( 'r( J <br /> Address: City: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> Lic. No: Company Name: <br /> Address: City: St: ZIP: <br /> LENDING AGENCY Ph#( ) <br /> Company Name: <br /> Address: City: St: ZIP: <br /> Permit will be issued to an"Owner-Builder" Yes WNo ❑ OFFICIAL USE ONLY <br /> If yes, a completed Owner-Builder Verification Form must Identification Number: <br /> be signed and submitted along with copy of the owner's <br /> identification prior to issuance of the building permit. <br /> DECLARATION BY CONSTRUCTION PERMIT APPLICANT <br /> By my signature below, I certify to one of the following: <br /> I am ❑ a California licensed contractor or❑the property owner or M authorized to act on the property owner's <br /> behalf(requires written approval and Owner/Builder Verification Form signed and submitted). <br /> I have read this construction permit application and the information I have provided is correct. <br /> I agree to comply with all applicable county ordinances and state laws relating to building construction. I authorize <br /> representatives of this city or unty to enter the above-identified property for inspection purposes. I <br /> Applicant's Signature Ay Date %`17J/ � <br /> For your convenience c ecklists detailing any additional submittal requirements for various building permit types <br /> are available at the Buil ing Division counter. Demolition permit and mobile home on foundation require check- <br /> list. <br /> F:\Application Forms&Handouts\HANDOUTS\Building Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />