Laserfiche WebLink
p4U`" BUILDING PERMIT APPLICATION <br /> {1 < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> i 1810 E. HAZELTON AVENUE,STOCKTON CA 95205 <br /> BUSINESS PHONE: (209) 468-3121 <br /> c4tiFOR `P 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: :;: iu 7 n t/ - -ew Z fw' rP <br /> Project Address: 6t Q (D 7- A he r ' F <br /> Project Valuation: Contact E-mail: <br /> d <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS <br /> NamiSenn Wer Y �v Name: ipI- <br /> Address: �jCj j rcd Address: ' o y <br /> ef <br /> City: State: City: r rp State: C.A. <br /> ZIP: Ph#VJp� DJ� 719 ZIP: ,<3ba Ph ' q) <br /> CONTRACTOR INFORMATION Ph#( ) <br /> Lic. No: Company Name: r <br /> Address: City: St: ZIP: <br /> W <br /> ESIGNER INFORMATION Ph#( ) <br /> Company Name:: City: St: ZIP: <br /> LENDING AGENCY Ph#(y Name:: City: St: ZIPill be issued town"Owner-Builder" Yes ❑ No ❑ OFFICIAL USE ONLY <br /> completed Owner-Builder Verification Form must Identification Number: <br /> d and submitted along with copy of the owner'stion 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 Ela California licensed contractor or❑the property owner ort 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 county to enter the above-identified property for inspection purposes. <br /> Applicant's Signature ( ? Date <br /> For your convenience hecklists detailing any additional submittal requirements for various building permit types <br /> are available at the iiding Division counter. Demolition permit and mobile home on foundation require check- <br /> list. <br /> FAApplication Forms&Handouts\HANDOUTMuilding Permit Application.docPage 1 of 2 <br /> (Revised(07-08-10) <br />