2207 / 7c0., 1 L Pala GI LOT'NO. A
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APPLICATION -FOR PLUMBING PERMIT
CITY'OC CIJP17RTINO
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s o Sanitaryuriry No.
o a Date C 2 - 196.3 Permit No;-2LoC(7�L_
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� ° Application is hereby made to the City of Cupertino for a permit to install plumbing
o r pipes and/oc fixtures listed on the reverse side hereof, and agrees to install said prices
r and/or'. xtures in accordance with the provisions of the Plumbing Code of the City of
wCupertino, and all other laws applicable thereto.
0w Use of Premises L�
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o a Owner
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J z BY COLSK-Z! 4e�t / �� !_ Address t`l 7 r �//O'
O NRACTOR,AGRNI
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a o State License-- �� Approve
//-" JJ PLUMBING 1NSPLCI'OR
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