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4 <br />CITY OF TRACY <br />520 Tracy Boulevard, Tracy, CA 95376 (209) 831-4600 (299) $31.4606 Pax. <br />BUILDING PERMIT APPt JCAMMN <br />ne rnformadorn on this form will be -used ,o prepare a permit for the applicant's signature <br />1. <br />.cb Address '`a:' W -: 1 1 � <br />^ a <br />t - <br />Assessor's Parcel No. (APN) <br />2. <br />Project Descripticn Fuc--= <br />Prcject Valuation <br />3. <br />Permit Class: X7 New ❑ Addition ❑ Remodel <br />Permit Type: fLv7, Building ❑ Mechanical j ❑ Eiectrical ❑ <br />Plumbing ❑ Sign <br />❑ PaoUSpa <br />❑ Demolition❑ RereeflSiding ❑ Fire Alarm <br />❑Fire Sprinkier <br />❑Other <br />4. <br />Property Owner;° C°d <br />Mailing Address <br />City/statetzip <br />4Phane OZt <br />- <br />5. <br />ArchitectlEngineer ipF <4e5; �,,1 - Rcxj <br />Address nV� <br />City/Statefzip 711- t`1r4 <br />Phone <br />S. <br />Contractor's Name _�,AG 1�1G �U I�1L1_f� air <br />Sub Contractor's <br />i❑Yes ❑No <br />Address P'dts4Nj VAtZE ;I J�LyPia5wvrcers Comp <br />❑Yes [::No <br />City/state/zip L t CPQ �4'534P, 3 <br />Phone <br />Contractor's License No.ITypesiExp. Date: CA L -)e- . � ��4 <br />867 <br />City Business License No1Exp. Date: <br />7. <br />Project Managers Name "Cs�=- _��-�'.{\!�{ ��1� <br />-- - - - <br />- -- <br />Maiiing Adcress <br />Ciiy/State/ ip <br />Phone <br />APPLICANT SIGNATURE `- -- �K— DATE <br />See Revorse side <br />W ?V-- we_ zt653050 Xr,��ez <br />2-d OOZE 13rM3SU-1 JH WdL0:a1 100e 06 AOW <br />