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I <br /> 14 �=- APPLICATION - BUILDING PERMIT <br /> (NO PLANS REQUIRED) <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1810 E. HAZELTON AVENUE, STOCKTON CA 95205 <br /> cgtlFOR`'�P BUSINESS PHONE: (209)468-3121 <br /> INSPECTION REQUEST 24-HOUR RECORDER: (2091468-3165 <br /> I <br /> PERMIT N0: © CAO(;?� <br /> T.rrs-e vi6'? Y '.�•1 'z <br /> 'THIS PORTION OFr �APPl.1 '[( 17 <br /> �Q ;E!!!�$I?'BE COMPLETELY FILLED;OUT BYTHE APPLICANT IN ORDER TO,APPLY f�OR�£f2MITS <br /> ,,e a_ r�. . <br /> Scope of Work: T_,S w /r aC I 00 a Vo Its <br /> OWNER NAME AND�ADDRESS pIYTCANT NgME AND ADDRESS' <br /> _ <br /> Name: Ja -G 10W leq5,-R a Name: <br /> D� f�, S��ciz>t-o Pv� <br /> Address: 3� � /�G Ssdn 1zd Address: (f<_ <br /> CState: Lf C', City: o �o^ State: Lcl <br /> ZIP J Ph:( 0$ ZIP: S zo <br /> Ph:( <br /> 1 <br /> " f el <br /> CONTRACTQgIJtIFORMATjON .. Ph:( > - 6 7 <br /> Lic. No:7ZV 77 8 Company Name: G <br /> Address: �j� s� �� I� �� City: SfoG12to St 4(A zIP 9 SZo3 <br /> APPL�Yy/�� tr� Ni <br /> (� ek_Esr Viz, <br /> ' � Z.pR�,Y�'�i•,^T `N.4'^�!'ufk'rt 5 1'4.i�I y�rT Rt. 4 Ylr'i Y} +f.� <br /> ONLY THE":OWNER OFTI R PEER�I(9AM CENSED,b N-T-,RACTOR�Iyq�;�gKE pUT�B�JIl.D1N,G P�R�MIT$ u,I,9• <br /> Own_ er-B ,�pr must submit the following with the application: Contractor must submit the following with the application: <br /> A property tax statement or a recorded deed. . Current license numbers. <br /> A completed and signed "Owner-Builder Verification . A completed "Authorized to Sign"form if other than <br /> form. the contractor applies (this is not necessary if this <br /> A completed "Authorization for Application"form if <br /> other than the owner applies. information is already on file with the Department). <br /> v ��.b .�,�,.r- EV <br /> m <br /> ' THIS SECTION TO BE=FILLED.OUT.ABY"DEVEL'OPMENT.SERVICESSTAFFw + <br /> .. - ... .. .. y:.a. 7...'kms t,: <br /> T Is> Technician: Date: <br /> Job-Site Address: _ _ APN:2 SS -3 o 07 <br /> -Cross-Street: _ _ City: _ ZIP: <br /> Precise Location: <br /> } -. ti x�f5y <br /> N, tiv,.� <br /> y'ts4t�Ce .< 4.,a aka rva �w 43 <br /> FBLDGMANDOUMPERWT APP-NO PLANS File#121(Rovi3eC 10-30.02) Page 1 of 1 <br />