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BUILDING PERMIT APPLICATION <br /> r- SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> '{ <br /> 1810 E. HAZELTON AVENUE,STOCKTON CA-95205 <br /> BUSINESS PHONE: (209)468-3121 <br /> c ' ` INSPECTION REQUEST-24 HOUR RECORDER: (209)468-3165 <br /> Niko <br /> THE APPLICATION MUST BE COMPLETELY FILLED OUT BY THE APPLICANT IN ORDER TO APPLY FOR BUILDING <br /> .PERMITS. <br /> Scope of Work: �ri�i rz t�v l (y��� _ v 7 <br /> Project Address: ' 6 'S i<. 61 fl �'_o , rF-k NL-i'1. C✓'m. <br /> Project Valuation:*I . U-7 Contact E-mail: <br /> OWNER NAME AND ADDRESS APPLICANT NAME AND ADDRESS- <br /> Name: S &I A O t..t- Name: _Fb kvy • S t N 1T ; S e f v'' ,'l ec <br /> JAddress: ?6 S_ E f'071'1" f' Address: `� t� v� (,f't C ;v, (c, ! <br /> City: C,"l-mr' State: G City: State: NV <br /> ZIP: z. 3 t Ph#(' �() t-th' - c S" ZIP: 0 G'1 Ph#(7P)) 2-8-7-, c 3 L,'q. <br /> CONTRACTOR INFORMATION �!s Ph#( <br /> Lic. No: Company Name: <br /> Address: �67 � City: St ZIP: <br /> DESIGNER INFORMATION 'Ph#( ) <br /> -Lic. No: G 5 2 s 8. Company Name: `vL ;n�,ti t i s .ri�,i��., j- 7vt u •( v� ) C. <br /> Address `; w ( M 2o-�f ? vz i S'4 c. f City: St: fit / ZIP: c �t I z <br /> LENDING AGENCY Ph#( ) <br /> Company Name: <br /> Address: City: St ZIP:- <br /> Permit will be issued to an"Owner-Builder" Yes ElNo OFFICIAL USE ONLY <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 <br /> - <br /> prior to issuance of the building permit. •' �' <br /> t DECLARATION BY CONSTRUCTION PERMIT JOY NIT <br /> lsignature <br /> .below I cerci to one ofollowing: =- <br /> f the <br /> Iz <br /> m[]a California licensed contractor or❑the-property owner-ar[�att1 ¢d td}ct; KPop �tjp � �k z <br /> half(requires written approval and OwnerBuilder VenfjcafonForrp srgi �!t -. .. �, �t���r",�4�";�f4 <br /> VVe read this construction permit application and certify the informatio i '. e r err Igo agt a to cohlply <br /> all a licable coup ordinances and state laws-which vert► <br /> PP county alsoN11 ' <br /> t�es;steps to preserve all survey monuments In additron; I at�thonz r the above- ' <br /> #Mfiedro <br /> p perty for inspection purposes <br /> z, <br /> carts Signature Signature <br /> t;or--your convenience checklis#s deta�lrng any additicfrel eulriritI requttefitls€or various buiiding permit types <br /> ace available at the Building Drvision counter: Demofit pn pe€ltit and mobile home on foundation require check-list. <br /> coo s t <br /> Hand outsWANDOUiS1Bu7ding P�rmtt�lpplicatlon t 2015.doc Page 1 oft <br /> 28-15) <br />