27194 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPERTINO HII,B r-MECTRICA L PERMIT NO.
APPLICATION/PERMIT PLUMBROJECTfIDENTICAL
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BUILDING DIVISION BUILDING PROJECT IDENTIFICATION 27194
BUILDIN1ADD1g/BSS: � ' 1 SANITARY NO. APPLICATION SUBMITTAL DATOl �[ , W LOTH
OW E SHAM' PI CO A. O 'SN LIC NO: NEC L LJ CONNTTRRO`L#
AR ITECT/ENGIR: LICNO: ADDRESS: ❑
CONTACT: PHONE: BUILDING PERMIT INFO
QTY. ELECTRIC PERMIT FEE
BLDG ELECT PLUMB MECH
PERMIT ISSUANCE
LICENSED CONTRACTOR'S DECLARATION APPLIANCES-RESIDENTIAL ❑ ❑
I hereby ffirm that lam licensed under p ( gwid, JOB DESCMMON
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WOO Section]000)ofDivision Jof the Business and l'rofasions Code,and my lic<nx is in PANELS
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