CITY OF ANGELS
COMMUNITY DEVELOPMENT

571 Stanislaus Ave., Ste. C
P.O. Box 667
Angels Camp, CA 95222
Building Inspector - 209-736-1346

REVISION TO BUILDING PERMIT

Applicant Date
Job Location APN
Property Owner Phone
Building Contractor Phone

Scope of Revision: Please describe in box below

Building Permit #_____________

I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY/CITY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES.

______________________________________ Date ________________________
SIGNATURE OF APPLICANT OR AGENT