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Building Inspection Division APPLICATION FOR INSPECTION REQUtO CITY OF TRNO
<br /> ACY
<br /> 52D S.Tr.P'N 95
<br /> City of Tracy BUILDING PERMIT (21�)936.2778
<br /> Tr. C.
<br /> 12n91 030-27375
<br /> 50
<br /> I 1 Jab Address 0DJj yBldg# Suile# solldivisiolt Lot#
<br /> Asscssnr's Pared No, J53-110 3431-
<br /> 2 Pro ecl Desch lion Or Comments 1AMAI_ -1 ', 0 a .elf 41 )
<br /> 3 Pennit Class ftwlAdd or AllcrlCunvcrsunLlRcnunlell MtM 'ASIPIX11cm
<br /> 4 Permit T"ypc Building Mechanical FICcirical Plumbing, Sign �•
<br /> M.1L Lot 4Dcniolition Gladol' Ocher 1
<br /> 5 Property Owncr(s) 1- iF0 J off U 2
<br /> Mailing Address citylsiale
<br /> Phone Nuniher Zip Code
<br /> 6 Occupant/Business Name Phone No.
<br /> Business Owner's Name
<br /> 7 Contractor's Nantc ':Af Hiring Licensed Contractor's(YlN)
<br /> Mailing Address 3180 R-UAlitE BLYO 1100 Citylslale IORRAHCE CA 90503.0000
<br /> Phone Number I 31d 742-317y Cont. Si. Liu.#
<br /> 8 Pm'ect Managers Namc Phone No
<br /> 9 Lendcr Namc
<br /> IU U.B.C.Group U.B.C. T e rlcithI FT Stories Plan Nu. 1000
<br /> [I Census, Area, Value.Assessntcrus: Census No. 0119 Privaic L)wncr?(YIN)
<br /> Cenp Census Number Description A/DIY Per Burg, BVD Units No. Sewer Water
<br /> Sub Code Arca/Value Code Per Bldg. Tens Tens
<br /> Code Or Cu. Yrds. Bldg, of Crm of crm
<br /> I' OEnr}ill[:I�T, ALL OTHER BLDGS 57,000 Sar 1 1
<br /> Total Arca Tial Value/Yards Zoning District
<br /> THE FOLLOWING PRELIMINARY FEES ARE SUBJECT T-O CHANGE BEFORE PERMIT ISSUANCE:
<br /> FEE I'EC.I
<br /> BLOii, TEE 901-1200-I10-ii1 FEE RIC.
<br /> F Ri ' "I iiljlp-4:0 utll
<br /> AECH. F(E 191 7200 100 424
<br /> litir. FNF 961
<br /> PLMB. i« 4D1 Ii06 IJ0 a2J
<br /> SAIF F.= IIGI'll(�AO-2il'OfE - \ '\
<br /> SMtR-4or,'w,901-uaua-221-JJIi _ [ �,�
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<br /> TOTAL FEES , p0
<br /> 0011111/ RAID as
<br /> BALANCE log >
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<br /> Application Number 11784 Permit Number 21471 Aeti"Il Cale 9 Y5 1
<br /> Application Date 9/23 95 Issuance Date 0!23195 Activity Daae B 23 95
<br /> Building Division Approval Date Planning Division Approval Date
<br /> Inspections are Required -- Request them 24 Hours In Advance
<br /> OWN ER/BU ILDEF0/1NFORMATION WORKERS'COMPENSATION
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<br /> LIU CONSTRUCTK)N.AMD HEr1FBF AU1Mp12E RE RESENTAINESOF TXI$GIN IO ENTER UPON THE ABODE P
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<br /> r n,b IM Cpnlacpr'e L4rnx law.l RECORDED ON THE JOB CARD ALL INSPECTION AEWES79 ARE RECUIRED 24 HOURS IN AO—CE OF
<br /> �T THE INSPECTION.
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<br /> WHEN PROPERLY VALIDATED • THIS FORM CONSTITUTES A BUILDING PERMIT
<br /> THIS APPLICATION ISABUILOINO PERMIT WHENPROPERL,IKLEDOUT,SKFNEO.AFIOPEIWR PEES AREPAIO,PERMISSION19 THEREFOnF GRAWFD IO DDSUCH WORK AS INrACATEO n rHISApM ICMK)NnAGCORMWF
<br /> WITH AND 9U6JEOr N.ALL OF THE PPPNI'$IONS OF THE BIpLDr1d CODE Of 1-19 CITY AM RELATED LAWS THIS PERMIT SECOMES NULL AND 1 O*W WORN IS NTS COWMENCEO W.-IN IAO DAYS rnoNI 1'.MIF DF
<br /> ISSUANCE-OR IF WORK IS SuspFNOED AT ANY nmr Durno CONSTRUCTKM FOR MORE THAN ISO GAYS AND PRCI D S FURTHER."AT SUCH SLPE" On ABOMOOFIur.r. HAS wi F-ri mr,Irl'tf AR '
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