26868 APPLICANT TO FILL IN INFORMATION WITHIN RED LINES-USE BALL POINT PEN ONLY
CITY OF CUPER'PINO BUILUI .-P.1,.CTRICAL PERMIT NO.
BUILDING DIVISION APPLICATION/PERMIT PLUNITING-MRCHANICAI.
BUILDING PROJECT IDENTIFICATION
BUILDING ADDRES, ` OY"j � Dr '?� SANITARY NO. AI'PL1CA'UON ItM11 A,L/A i
ou (/ UNIT# LOTM
O SNPME: PHONE*
HO G C TRACE k'SN E: T LICN NIC CONIROLp I
A�"D• ,, 0•-�3 _ eo
SRCHUIzCI'/INGI FPR: LIC NO: ADDRESS:
sea 1-311 ,'R44q aae *ra4? uaj,
ONTTACII;; - PHONE: QTY. ELECTRIC PERMIT FEF, BUILDING PERMIT INFO
dga BLEG ELECT PLUMB MECH
46'4' j PERMITISSUANCE Y 2-QD �iT & �I
LICENSED CONTRACTOR'S )li RA 1 APPLIANCES-RESIDENTIAL f'y
Metz Iherebyufr,.that lam licenseAunderparoki...orchapter9 fcommereaRv It JOB DIiSCkIP'1'IUN
woo `eetull im77000)ofDivision Sof the BusinessLagn.�d�Prefeatiions Cade,mal my license is in PANELS
Qyty License Clasorce ands_uc.g Ygssaa UP TO 2M AMPS S
Lo<d Date Contract., 301-1000 AMPS
F K ARC]I I I'I?