945 IZ-Cel e) I /)-,7/J / &jf 4 LOT NO,
NO.
0
z 1 FOR PLUMBING PERMIT
CLI��.D� +9 nT
to N.
Date 7O OF CUPERTINO
Ile- 1, �.� G ��
� Permit No.
CITY 0€ FeeFYI
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
,v 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
:a
N Owner 1Y • klz§7 7411 - "�/J� 4 Ere/`
Address
By-6n'-0-A'7'LL�Q�vG JrrFTan�rYZ _\ Address O 7 /9
CONTR�A�T OR AGENT 1
Phonwy f - 3 5/�f ApprO e
.� `/ PLUMBING INSPE OR
H r
Ci1 C.
n z
0
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tron Oro � cn .� Nrn � a0 zada rn
0 � �� o 0 0 o w �'
j a i 3 o c a n a m ro n n
I, the undersigned do hereby cert, that I am
the ovmer and c upan £ the single family dwelling at
i I ox- v P"'I F}- , for which I sur, making
application to dork as a home owner.
also certify that Iv. 11 of hire any nun-licensed i
d'bntractor, but will do this work myself.
TELEPfiO iE P1UMB ",7; _ SIG UTURE