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o (E)APPLICATON F,jR PERMIT
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<br /> CITY OF L001 - Building Inspection Division 221 West Pine Street/�006 Lod' !', CA 9 I
<br /> 52411910 .
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<br /> I Job Address
<br /> i' Assessor's Parcel No. X3-053-0002- - Bldg! , Suites Subdivision.}, ,'�tl Louf
<br /> 2 Project Description Or Comment% _
<br /> 3 Permit Class(New/Add or Alter/Conversion/Remodel) L'T'-4. r'ii`3`r
<br /> 4 fYrmit T)•pe Building Mechanical Electrical Plumbing1.
<br /> Pool/Spa x Demolition Retool/Siding Other
<br /> S Property Owner(s) I. j
<br /> Meiling Address 636 DAISY AV � 2. :., LODI CA
<br /> 1 Citylstate ;fit a
<br /> Phone Number :Zip Code 45210-8000 r•
<br /> 6 OccupanyBusiness Name M.
<br /> Phone No.
<br /> Business Owner's Name
<br /> 7 Contractor's Name t :Hiring Licensed ContracWr s(YIN)
<br /> Mailing Address P.O. Bu[ 1021 r CitylState. :.QST SACTO .CA ,?Sd91-�000 ,'` f�
<br /> Pbone Number 1 915-372 7535 y`Cont.St. Lic.! 51003; r I. iP F
<br /> 8 Pro•ect Mama rs Name ! F'hane No.
<br /> 9 Lcnder Name City/State+::-._,^ :Y r H,sM>• r fys
<br /> 10 U.B.C.Group U.B.C. Occ.Load Stories.•°:P' YS:-E an ,:•.DM
<br /> Pli >
<br /> 11 Census,Area. Flue,As
<br /> sessments: Census No. Private Owner?
<br /> CenN Census Number Description AID/Y Per Bldg..; BVD Units No..° Sera _Water
<br /> Sub Code Ama/Valtle '• Code 1'er .BW _ 7t=r
<br /> g Service T�
<br /> Code Or Cu Yads.' Bldg. €Uaitr 1 of.dm .Zm x ; ,
<br /> F DEMOLITION, FUEL JAMAEIUIVA! f F 30.1
<br /> 1 T ;
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<br /> Total Area Total Value/Yards Zoning District ev rt-i '
<br /> THE FOLLOWING PRELIMINARY FEES ARE SUBIEZ4TvO CHNOE BEFORE PERMIT.ISSUANCE:',.`-Li,,
<br /> BUILONG PERMIT FEE 23.00 PARKS/REC. FEES
<br /> PLAti CHECy. FEE OIL. PLAIT IVIEN Mt?
<br /> MEC114111CAL EQUIP, FEES AQDL. UBC FEES Vit;
<br /> ELECTRICAL EQUIP. FEES ADffIHISTBATIYE FEES • '" ^•xr-,
<br /> PLUt1BIM6 EQUIP. FEES ADDL. SERVICES
<br /> L.U.S,D. FEES - I
<br /> S.tt.LP. FEES
<br /> SEk'ER CONNECTION FEE r
<br /> WISP. CONNECTION FEE
<br /> TOTAL FEES ! .25.00 °
<br /> ANOUMT PAID f .00
<br /> RALAIICE U 25.00 s
<br /> Appiieation Number 40454
<br /> Permit Humber Activity Code �-
<br /> Application Date 8123189 l ���
<br /> Issuat5te Date L� Activity Date $!2$184
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<br /> OWNERIBUILDERMNFORMATION WORKERS'COMPENSATION
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<br /> WHEN PROPERLY VALIDATED THIS FORM CONSTIT TES A BUILDING PERMIT
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<br /> White-Street File Yellow-Permanent File Pink_Customer Copy Golden Rod-WQrkingCopy
<br /> .-•-� BID.12 B-M ' ,
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