25282 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINOILDING-E1TCT111 A, PERM]I No.
APPLICATION/PERMIT PLUMBING-MECHANICAL 25282_
] [� n � Lg]
NUILUING DIVISION BUILDING PROJECT IDEM'IFIC.SI'[ON L J L
BUILDING ADDRESS: SANITARY NO. APPLICA DON SUBMITTAL DATE
E� On/ !3 UNIT LOTH 13316' 7, � "% 7
OWNER$ � � 1:). //�� COM'R ORC� 1 LI NO:
l/% IJ/6 `I $/$/// �T D !(p L6C.a �} !��/ NIC CONTR(lLN
� MW
ARCUI RiCI'/Il1G 13I3R: LIC NO: ADDR /I�Jf� /'T/I� El
CONTACT: PHONE: BUILDING PERMIT INFO
MINI Al E W y&i f(4 co) r5 ( QTY. ELECTRIC PERMIT FEC
3 /ISN BIAG ELECT PLUMB MECII
PERMIT ISSUANCE 1:1 El � ElLICENSED CONTRACT OR'S DECLARATION APPLIANCES-RESIDENTIAL
OSZ Ihereby affirm Out l am licensed underpmvisioesofC'hapter 9(commencing with TOR DESCRIPTION
FOO Section 7000O.f Division 3 of the Business and Profenioa.0 sand my liceroe is in PANELS ^�'n ,�_ Ov/
xtF Oilforn undcffb. �l LieN � —3)7U C� aw-�l
FZG Lice Ian [� IO UP TO 200 AMPS
c" Line Date Contractor G 301-1000 AMPS
ZS'-Z ARCIII'IECIESDECLARAI ON OVERION)AMPS SQ.17.FLOOR AREA 5/SQ.IT.
Oz—a 1 understand my plum shall be used as public nmNa E I [ �g
1=