B-2017-0403 ApplicationCUPERTING
GENERAL PERMIT APPLICATION
COMMUNITY DEVELOPMENT DEPARTMENT • BUILDING DIVISION MEP
10300TORRE°AVENUE-- CUPERTINO, CA 3st1'l4-3235 .
(408) 777-3228 - FAX W8) 777-3333 • buildlng@w2ertino.orid M ..
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By my signatum below, I certify to each ofthe fallowin.&: I am the property ownerorautborized agggent to actor thepriperty owner's bebal£ I hacereadthis
application and the information Ihave provi -
ves of Cup ertinno to enterthe above= end ged property for inspection purposes.
Siggmatnrc of AppiicangAaent: ' f'd If 7
SUPS 00 REQUIRED
11-511, v SYF:OIWCE = . ON.-
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' hJEPA9iscctlpp 2011.doo revised 03116111