05050054 CITY OF CUPERTINO S
REPIPE/SEWERS/MAIN SERVICE C�Sti 5
CUPERTINO PERMIT APPLICATION FORM
APN# ate �k
2 vt
Building Address:
Owner's N Phone#-
F, /
gontractor: icex\ Iom nhone License#:
-151 _
ntact: I o 4oa _ _ Cupert ysin ss License#:
Building Perimt Info:
Bldg ❑ Elect ❑ Plumb
Job Description:
Residential Commercial ❑
Cost of Project:
Qty. if
Applicable Fee ID Fee Description Fee Group
PPERMTTFEE Plu—mbing 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
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