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BUILDING PERMIT APPLICATION <br /> ''• SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> { f•, 1810 E.HAZELTON AVENUE,STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)468-3121 <br /> `�'FOINSPECTION REQUEST-24 HOUR RECORDER; (209)468-3165• <br /> P <br /> It <br /> THE APpLiCATION MUST BE COMPL$TELY FILLED OUT BY THEAPPLICANT IN ORUER.TO APPLY FOR <br /> BUILDIN P RMITS. <br /> �Ope of Work: / <br /> ProJectAdd ess' 2 1"3'S ' a' <br /> ProjectValuatlon= ILL <br /> Contact <br /> OVVNER NAM AND ADDRESS. APPLICANT NAME AND ADDRESS <br /> t,. O✓1-C,. .:... .:':: _:::' Name: <br /> Name: ` <br /> Address: (Lj ° r Address: , <br /> State: i.. ._:, . City: State: <br /> zip: \ Ph#( J�1. ZIP: Ph#( ) <br /> 21P: � l`'s - G - <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Company Name: <br /> Lic.No; <br /> City: St: ZIP: <br /> Address: <br /> DESIGNER INFORMATION Ph#( ) J <br /> Company Name:.. . "' <br /> Lic,No: <br /> City: St: ZIP: <br /> Address; <br /> LENDING AGENCY Ph#( ) <br /> Company Name <br /> Address: City: St: ZIP: <br /> ed to an 'Owner Yes n No❑ OFFICIAL USE ONLY <br /> Permitwill be 1, aOwner-Builder Verification Form must Identification Number: <br /> If yes, a complete Bed along with copy of the owners <br /> be signed and sub olissuance of the building permit. <br /> w=;•;;.=identification prior <br /> DECLARATION(BY CONSTRUCTION PERMIT APPLICANT <br /> I W, I certify to one of the following: <br /> gY mysignaturo beicensed tor or <br /> ( to act on <br /> am Ela CaliferWi�(en approvaltracand Owne�r(BulldertheoVenfi aHonrF rm ignedor ufLzed and submtffed).e property owner's <br /> behalf(requires <br /> I havo read this construction permit application and the information I have provided Is correct. <br /> a ly With all applicable county ordinances and state laws relating to building construction, Lauthorize <br /> gree to comp of this cl or county to enter the above-Identified property for Inspection purposes- <br /> re <br /> presentattves n <br /> Applicants Signa <br /> dor your convent e Building Division counter. Demtolitioin permit end mobs a hmeIremonts er various on foundationding require checermit ks <br /> are.avarl5bie_ati th <br /> �t VPsled(07 Ott 10) &NB�oatslHANbOUi8IBuilding Permit Applicatlon.docPage 1 of <br />