23204 (2) APPLICANT TO FILL IN INFORMATION WITHIN RED LINES — USE BALL POINT PEN ONLY
Building Proed Identification I
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2 PELwi NO.
Building Address: n�n O A
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a one: A
CITY OF CUPERTINO-BUILDING DIVISION 1 f
o;,ntrador./N�. /y /' LIC,Nm APPLICATION / PERMIT
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" -" l ONJ T7� �(.,C BUILDINGELFICTRICAL-PLUMBINGMFLHAMCAL CATEGORY CONTROL
rehired/Engineer. Lie No:
. ELECTR I@P.EtaR'nnMTTjy, Y"y
Addm..3�70-Dv)u;