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■ <br /> CITY Of TRACY SOUTH SAN JOAQUIN COUNTY FIRE AUTHORITY <br /> ZA& DEVELOPMENT SERVICES COMMUNITY RISK REOUCTION DIVISION ��' QfJyr <br /> 333 Civic Center Plaza 835 N , Central Ave. <br /> TRACY Tracy, CA 953716 Tracy. CA 9S 376 <br /> Phone lel g phone 1209) 1231 =G707 <br /> Fax (209) >?<31 -CA39-6139 [�w,elanttleSk �s rfi�o�i, <br /> plantheCk9cltkoftrac7t, or$ <br /> 4 MINE <br /> (�1(�( <br /> Swung Permit ll: Frre permit #1 �" � � � L/lJ �+' <br /> BUILDING & FIRE CONSTRUCTION PERMIT APPILICATIO" <br /> IPI EA% F PHINr tLLARLYI <br /> Inorder hr pftow", dk� iln procruiog the aWk*1;ori, pleare eornplete op burn on thh WiParado"- <br /> Nx"P$rt ► appkvtians Wray be 4virtted w drlayrd fur Pra�rWg- <br /> GENERAL IMFORINATIDN ) <br /> Project Address <br /> Does the project have a suite number(5)7 Unit / Suite g1sj : Aaesso& Parcel Number WN): <br /> I 1 yes No Unsure MINE <br /> _ <br /> Scope of workAlt <br /> ValuaRlott: Estimated Project Completion Dabs: _ <br /> Square Footaga: Consfinzc0on Type: pccup.rr►cy Type: <br /> CONTACT INFOR64AT1OM Million MONOMER <br /> PROPERTY OtM1in _ CONTRACTOR _ <br /> Name: I/ ersmpaPly: <br /> ctsg M; Bus. Ue. fel <br /> Address: Zi :/ Address. _ <br /> City & State: � v �� Zip: Q _ Ciry 8 State: <br /> Zlpe <br /> Phone X. i � Phone 4. <br /> E-Mail : E Mau; T �al Q F _ /C • <br /> DESIGNER/AIlO1RECT ENGINEER OF RECO <br /> Name : Name : <br /> Address: Address: <br /> Crty A State: Zip: Gly $ State: Zip: j <br /> Phone N: - Phone a-. <br /> E=Mall : - E- Mall : <br /> TENANT APPLICANT f <br /> Name : Name: /¢ /2 / // ,/ � G <br /> Address: - - - AddreSs: <br /> City & State: Zip: Gty & State: Zip: g <br /> Phone p: Phone 4: 19 +� <br /> E-Mail : �_- &Mall <br /> ly4jz 'TGro <br /> ACKNOWLEDGEMENT <br /> As the Applicant of this project, I agree to the following: <br /> 1 . ) The owner of the referenced property is aware of the proposed work and authorizes the submittal of this application for construct <br /> 2. ) I acknowledge that prior to any review, plan review fees must be paid at each Division separately. It is my responsibility to contact <br /> Division to make payment arrangements. <br /> 11 Any plan review becomes null and void after ONE HUNDRED EIGHTY ( 1$4) days of inactivity by the applicant to fespoltd to plan rq <br /> corrections, <br /> 4. ) The information and statements given on this a ication, construction drawings and specificatim are true and correct, to the bel <br /> knowledge. nn <br /> ApplicataSiSnature: <br /> i <br /> I <br /> tw..Mr IanW�-•+rQ/ N.r drri. A,'..... i <br /> 2 <br /> i <br />