1097 '—
i o I o C i �s —r)ez LOT NO.-
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APP T FOR PLUMBING PERMIT
Il D f APR 10 �� OF CUPERTINO
Dat psi nr tUPEOINO 19CZ Permit No. D 7s
Fee $ ��
Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
�p and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws
applicable thereto.
Use of Premises
y Owner e Address
By Address
CONTRACTOR, AGENT
Phone VIV 3 ct' _ Approved
"K PLOMBI INSPECTO
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