03040071 CITY OF CUPERTINO
I BUILDING DIVISION PERMIT ��N�CTOR�TN,;TSU?
r 3 � 071
CITY OF CUPERTINO
REPIPE/SEWERS/MAIN SERVICE
CITY
CUPERTINO PERMIT APPLICATION FORM
APN# 17 , Date,
Building Address:
Own ' Name: !•l Phone
6 . 7 ZO a
Con acto �M G Phone: License#�...
Contac : � Pe; �9d�JoGO Cupertino Business License#:
Building Permit Info: �7
Bldg ❑ Elect ❑ Plumb qsJ
Job Description: 1, , L ?41 CjQ
Residential ❑ p Commerce' 1
Cost of Project:
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Qty
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AppljEal5jq Fee ID Fee Description Fee Group
PPERMITFEE Plumbing Permit Issuance PLUMBING
BPREPIPE Re i e of Fixtures PLUMBING
BPERMFEE Bldg. Permit Fees BUILDING
BPFIXTURE Pbl . Fixture PLUMBING
BPWSVCS Main Water Service PLUMBING
BPSEWER Sewers PLUMBING
BPSEWAGE Sewage Disposal PLUMBING
BUSLIC Business License BUILDING
7 7
17