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CITY OF TRACY <br /> otp <br /> „ it COMMUNITY DEVELOPMENT DEPARTMENT <br /> 9 d <br /> ° N 520 Tracy Boulevard,Tracy, CA 95376 (2D9)831-4600 (209)831-4606 Fax <br /> V � o <br /> `y�o, �8► � BUILDING PERMIT APPLICATION <br /> The information on this form will be used to prepare a permit for the applicant's signature <br /> 1. Job Address �� QQ AAmtI`t �ZrS0s, <br /> Assessor's Parcel No. (APN) <br /> 2. Project Description U(\Aoqcqf)( A 'TQ �erncval <br /> Project Valuation _ �0 uI<Z — <br /> 3 Permit Class: ❑ New ❑ Addition n Remodel <br /> Permit Type: ❑ Building ❑ Mechanical ❑ Electrical ❑ Plumbing ❑ Sign ❑ Pool/Spa <br /> ❑ Demolition (] Reroof/Siding ❑ Fire Alarm ❑ Fire Sprinkler Other <br /> 4. Property Owner 0 n� �yr C V �I YIO�kesw) tR� Tceri k m�M* pI Q ir. <br /> Mailing Address �'qcy--' ZIA <br /> City/State/Zip Tyr4 C s a C 3 Phone -2'3 I <br /> 5. Architect/Engineer 15;gA4e- 41 11/ 7 <br /> Address <br /> City/State/Zip Phone <br /> 6. Contractor's Name Y)C( rt'c-• �i gNSub Contractor's ❑Yes 0 <br /> 7. Project Managers Name I� <br /> Mailing Address 41-to (j _i - <br /> nAe-c c � tyk <br /> City/State/Zip Tei— O P C� S 31 (,0 Phone <br /> APPLICANT NAME 116k rh\- (- t1 V�2�n ry\ � u� �l'e Q 1 CC' S- <br /> ADDRESS gZZO <br /> CITY/STATE/ZIP C I PHONE oQ p�� �033-0]yS <br /> APPLICANT SIGNATURE DATE q - 2-1 - 9 -7 <br /> �� } Ira c Ce V. "VA bc-ve �l y"o D kr w Q u U <br /> GZ0 <br /> "'. 39vd A ` AOVdi JO ALIO 9094LE060Z SD:LL L66L/ZZ/60 <br />