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Mar 24 03 10:468 San Joaquin County 46831.27 p. 1 <br /> j wis imauw canes <br /> »+e e.waa�ow mm'OT60g7 N.w► <br /> neowerow�awie,I Fuc:ctauaa.s�m <br /> OWNER/BUILDER VERIFICATION FORM <br /> AUTHORIZATION FOR APPLICATION FOR PERMIT(6)BY MHER THAN <br /> THE PROPERTY OWN"OR A LICENSED CON'T'RACTOR <br /> 1, as the owner of the property, understand or have been informed that the application for a Buildin , Plumbing, <br /> and/or Electrical Permit must be signed by the owner of the property, his duly author zeal agt nto.r a licensed <br /> i <br /> contractor. <br /> I am also aware that I may designate a third party,such as a tenant or person in my employ,to sign the application for <br /> a permit on my behalf I understand that the person's only responsibility or function is to acquire a permit on my <br /> behalf. <br /> i I am aware that the responsibility for the construction and compliance to codes and ordinances is entirely mine and I <br /> agree to accept the sabre. <br /> E Theroforc,ae the owner of // s 1<4 c=S°C;14.7 /� <br /> (Addre"or the site where work wtU he performed) <br /> I do hereby authorize <br /> (Name of person auttionzed to obtain permit) <br /> to obtain a^ <7 <br /> (TYPr of permit and description or work) <br /> in my name by affixing my name followed by his or her sigrtxlure on the application. <br /> CM-ner's Signature <br /> yt ncr's Address/ ty r <br /> (( �Y <br /> Owner's Telephone umber <br /> FILL OUT BOTH SIDES OF THIS FORM IF BOX IS MARKED <br /> II� <br /> E2 3OVd IOBOSOZSZ61 I c3hz)I A I Z)Vd to ZL flti31600Z 4L HVri <br />