Laserfiche WebLink
BUILDING PERMIT APPLICATION <br /> ii IIS K SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 6. 4810 E. HAZELTON AVENUE,STOCKTON CA 95205 <br /> BUSINESS PHONE: (209)468-3121 <br /> o INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> �liFORa�P <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br /> PERMITS. <br /> Scope of Work: UNl Gr ct m)�,� c�.w� titr y FI <br /> Project Address: t' 6"D T41 {" '.{ n ,i'1. C3r ?/4 <br /> Project Valuation:$i • c- 7 Contact E-mail: izti(t•I t {' <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND.ADDRESS <br /> Name <br /> `�-> ��"t C,i LL Name: ea 1�`1 S+ !�,C. � ; az- I'r<U�i=t7 nrarTa�-tt <br /> Address: �_?,CS L i2¢ t+� ��p � Address: 7 '�3 ,� �. ,t t ,mac 1' » �v77 •�7+ 3 �, <br /> City: State: c City: State: N=J <br /> ZIP: ; 3 ; Ph#(LC'0 L.i ci t� G C ZIP: s, Ph#(")W>) <br /> CONTRACTOR INFORMATION -T gg r Ph#( ) -- <br /> Lic. No: Company Name:, <br /> Address: ' """ �s 0 <br /> / city: St: ZIP: <br /> DESIGNER INFORMATION Ph#( ) <br /> _Uc� No: 6 `> __ 8. Company Name: C ;i, ,.1, ; • c 1' <, U�,r, =v s .( i„c. <br /> Address:7`,? > 10 ( ._ me_ 4 t?!, ai s ,; <br /> City: ' L F�� Ar`e-'�{,-� St: j�l�j ZIP:� c 2, u” <br /> LENDING AGENCY Ph#( ) <br /> Company Name: <br /> Address: City: St: ZIP:- <br /> Permit will be issued to an"Owner-Builder" Yes❑ No 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 PERMITAPPLICANT <br /> By my signature.below, I certify to one of the following: <br /> Earn [] a California licensed contractor or❑the property owner or authorized to act on the property owner's. <br /> behalf(requires written approval and Owner/Builder Verification;Form signed and s1u6miff <br /> 15 ave read this construction permit application and certify the information I have provided;ls correct: r:also agree to comply <br /> Vith all applicable county ordinances and state Taws which govern this protect 'Punng the coutse.of construction I will also <br /> takes steps to preserve all survey monuments. In addition, I authorize represer}tpftues of thscounty.to enter the above <br /> ntified property for inspection purposes. <br /> Applicant's Signature bate <br /> For your convenience checklists detailing any additional submittal requirements for various building permit types <br /> aFe available at the Building Division counter. Demolition pe`rmi and mobile home on foundation require check-list. <br /> p>!1n,�.tiPnFonns&.HandoutsWANDOUMBuilding Permit Application-1-2015.doc- Page 1 oft <br /> r,., <br />