1753a0?7i1 LOTNO.
NO. STREET
�A. PPLICA IONS FOR PLUMBING PERMIT
CI
J1 SOF CUPERTINO
Date VAU�2/?/P629�. Permit No. / 76-3CITY OF CUPERTINO 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
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
8 Use of Premises
� owner
C.FSr-
g�agne SOFT WATER SEAV�
1040 Loa9f+a4teaa'oA,venmw
Phone�inbell. California
Address
Address
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P u"", INSPECTOR
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