Laserfiche WebLink
BUILDING PERMIT APPLICATION <br />SAN JOAQUIN COUNTY CC)NIMUNITYDEVELOPMENT DEPARTMENT <br />189aO E. HAZELTON AVENUE, STOCKTON CA 95205 <br />BUSINESS PHONE: (209) 468-3121 <br />INSPECTION REQUEST -24 HOUR RECORDER: (209) 463-3165, <br />THE APPLICATION MUST BE COMPLETELY FILLET.? OUT BYTHEAPPLIGANTIN ORD,ER-T0 APPLY FOR <br />BUILDING PERIMITS. <br />Scope fj <br />Project Address: <br />aRjv <br />Project ValLat on: tact E-mail: <br />OWNER NAME AND ADDRESS <br />APPLICANT NAME AND ADDRESS <br />Name, <br />Name, <br />Address -1,111W) <br />City:j state- <br />icily- State: <br />ZIP: ZIP: q0 Ph#(,)KA S SS 2, 1 <br />CONTRACTOR INFORMATION Ph#( <br />L ic. No: Company Name,. <br />Address: <br />City, <br />St ZIP: <br />DESIGNER INFORMATION 1,4 <br />1-1c, No:, Company Name - <br />City. <br />LENDING AGENGY Ph# <br />Company Name: <br />Address. <br />city: <br />St ZIP: <br />Permit will be issued to an "Owner-Buildef' Yes El No <br />OFFICIAL USE ONLY <br />Identiftation Number. <br />If yes, avornpleted Owner -Builder Verb icatjoii,Fdrrrin)usL,, <br />be signed and submitted along with copy of.thb'o%14ne'rs <br />identificrition prior to issuance of the building permit <br />DECLARATI04 BY", NS "APPOCANT <br />By rny-s;Ignature below, I certify to one of the following: <br />I -,am F1 a California licensed contractor or 0 the propertyO'W'N'�r.'�;'l authorized to act on the iroporty owners <br />behalf (requires written approval and Owner/Builder Ven cat ohnoorm, signed and submitted <br />I have lead this construction permit application and the provid0:1s:(41fT16C <br />i nice to comply with all appiicable cDunty ordinances and state laws ielatin,g,to bqilidin6'/c rritru iort I authorize <br />representatives of this city or county to enter the above -identified p pines <br />ro rtYllor" P�""� <br />Applicant's Signature to <br />For your convenience checklists detailing any additional submittal. -re" ulremints,for)iarlous building permit types <br />are available at the Building Division counter. Demolition permit an4mobil n foundation require chock - <br />list. <br />F:\Appr1cz4i_r) Forms -I Hamlout\HANDOUTS'BiAding Perrin AppfimWn.d0cpage 1 of 2 <br />'Revised <br />