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C•Y OF LODI • PERMIT <br /> COMMUNITY DEVELOPMENT DEPARTMENT APPLICATION <br /> Building Inspection Division <br /> • 221 West Pine St/P.O. Box 3006, Lodi. CA 95241-1910 <br /> (209) 333-6714 <br /> 1. Job Address Subdivision Lot# <br /> Assessor Parcel No. Subdivision Name <br /> 2. Project Description <br /> 3. Permit Class: ( ) New ( ) Addition/Alteration/Remodel ( ) Repair <br /> 4. Permit Type: ( ) Building ( ) Mechanical ( ) Electrical ( ) Plumbing ( ) Sign <br /> ( ) Pool/Spa ( ) Demolition ( ) Site Work ( ) Other <br /> 5. Property Owner(s) 1. 2• <br /> Mailing Address: City/State <br /> Phone Number ( ) Zip Code <br /> 6. Architect Engineer City/State <br /> Phone Number ( ) Zip Code <br /> 7. Contractor Using Subcontractors (Y/N) <br /> Mailing Address: City/State <br /> Phone Number ( ) State Lic Number Class <br /> ' 8. Project Manager's Name Phone Number( ) <br /> 9. Lender Name: City/StateZip <br /> 10. Applicant Name Phone Number( ) <br /> Mailing Address City/StateZip <br /> NOTICE: Applications for which no permit is issued within 180 days following the date of application <br /> shall expire by limitation, and plans and other data submitted for review may thereafter be <br /> returned to the applicant or destroyed by the building official. <br /> APPLICANT SIGNATURE Date <br /> Application Accepted By Date <br /> 1S..p1R68MW6aBG $l'J97]:bY% <br />