Laserfiche WebLink
02/05/2014 09:55 7607712113_ BARBARA DONDERO <br /> PAGE 02 <br /> to =SANBUILDING PERMIT APPLICATION <br /> AQUiN COUNTY COMMUNITY DEVELOPMENT DEPARTME� T <br /> '1810 E.HAZELTONBIJAVENUE,STOCKTON CA 195205NgPECTfON REQUEST-24 HOUR RECORDER:R.1NESS PHONE: (209)468-3121 <br /> (209)468-3165 <br /> THE ApPLiGATION MP§1 BE COMPLETELY FILLET]OUT gY THf= 115 'I't It''A iN ORDER TO APPLY FOR <br /> h f3(�It131NG RERhgt� � <br /> Scope of Work: vC <br /> UU � <br /> Project Address: <br /> Project Valuation., <br /> Contact E-mail: <br /> OWNER NAME AND ADDP.t±$S <br /> Name: APPLICANT NAME;AND ADDITE$S <br /> Address: H Q6` <br /> ZIP: ZIP.. vim (n -- Ph# <br /> CONTRAC-TOR INFORMATION <br /> Ph#( j <br /> Lie. No, =Company Name: <br /> Address; --------,.r. <br /> .............................._._.. city: <br /> t7ESIGNIER INFORMATION St: ZIP: <br /> Lic. No: 2t�3 Company Name: <br /> Address' � • �PY G h <br /> LENDING AOI: Cy Ph#( ) zip: 570 <br /> Company Name: <br /> Address; <br /> City: St: ZIP. <br /> Permit will be issued tp an"Owner-Bullder' Yes❑No❑ OFFfC1�l USE LY. <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 /> DECLAI,ATION BY CONSTRUCTION PERMIT APPLICANT <br /> BY my signature below, t certify to one of the following, <br /> 8M IJ zi <br /> nia licensed <br /> by a1ff(requ lresrwritten appro altand Owneractor or r/uilde oVerifl ationF pey owner <br /> r <br /> ❑authorized fo,pct on the Property owner'sorm signed and submitted). <br /> I have read thrq construction permit applicatlon and the information i have provided is correct, <br /> I agree to comply with all applicable County ordinances and state laws relating to¢abiding construction. I authorize <br /> representatives of this city or county to enter the above-identified property for inspection purposes. <br /> Applicant's Signature � � -" <br /> For �-- <br /> o your Convenience checklists detalHn — <br /> Y Demitolmittal m <br /> oition permit and mobile hameievrnents a <br /> are available at the Building Division counteran faundatlolndrequler it types <br /> list, <br /> F:kAPptiMbon Forms&HandoutsV-!AND0UT8I5uflding P©rmit ApPIlcatlon.docPaga 1 of 2 <br /> (RWAgLd(07-05-10) <br /> I <br />