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FILL OUT BOTH SIDES IF CHECKED HERE <br /> AL-I'siORIZAT=ON FOR ?-P-PLICATION .O}? Pr ;T(S) <br /> BY OTHER TF_kN OWNER OR LICENSED CONTRACTOR <br /> TO: San Joaquin County Community Development Department <br /> 1810 E. Hazelton Avenue <br /> Stockton, CA 95205 <br /> Phone (209) 468-3123 <br /> I, as the owner of the property, unders-and or have been informed <br /> that the application for a Building, Plumbing and/or Electrical <br /> Permit- must be signed by the owner of the property, his duly <br /> authorized agent or a licensed contractor. <br /> I am also aware that I may designate a third party, such as a <br /> tenant or person in my enplov, to sign the application for a permit <br /> on my behalf. I understand that the person's only responsibility <br /> or function is to acquire a permit on my behalf. <br /> -T am aware that the responsibility for the construction and <br /> compliance to codes and ordinances is entirely mine and 1 agree to <br /> accept the sa.-,ie. <br /> Therefore, as the owner of the property located at <br /> E. A060S1_H-- S 1 . WDDD3R� D.(SE CA- , 95 2 SE , <br /> (Address/City) <br /> r do hereby authorize u SCWCxf 0�_, <br /> 7 (Name) <br /> C <br /> to obtain a� Re51 els-# 4 O l in my name by affixing <br /> �'� (Type of Permit) <br /> my name followed by his or her signature on the application for <br /> KeS� �u� ►�. er m t <br /> r (Typo of Per <br /> it) <br /> OW-NIER'S SIGNATL"RE <br /> OW?i ER' S ADDRZSS/CIT C Ml LOD{ CW� • <br /> OWNER'S PHiONE NU_ R Z� 333- OqG DATE 5- — <br />