1535 LOT NO.
NO. STREET
�L N FOR PLUMBING PERMIT
DOF CUPERTINO
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DIN 8 962 195_ Permit No.
QTYCITY OF CI Q11NQ Fee $
is here y made tot e 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
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a� Cupertino, and all other law pplicable thereto.
Use of Premises
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Owner Address
I/III _ Address ;
OA, AGET
LL[ Phone Approve
PLUMBING INSPECTOR
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