51344LOT.NO. 17
CITY OF CUPERTINO
APPLICATION FOR PLUMBING PERMIT
CgY Fjr rs¢ O ,*
R ( 1976 Sanitary No.
Date 119 Permit T
Pis AT
� jj�� Feee $
E
Application b)mE"de 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.
Use ofork To Be
Premise ��� Performed
Owner Address
Phone
Bynt..,.,.. o.. -
Coractor, Agent
Phone
State LicenseApproved plumbing Inspector
I AGREE I WILL NOT VIOLATE ANY OF THE WORKMEN'S
COMPENSATION LAWS OF THE STATE OF CALIFORNIA.
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