991 15771U /2/'&,/e,/7- IDYL LOT NO.
NO. STREET
a APPUICATION FOR PLUMBING PERMIT
r' CITY OF CUPERTINO
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Def -AA �-��Qlo� ,`193— Permit No. � ` l
AICITY �F CUPERTINO Fees
�t App !c'ation is hereby made to the City of Cupertino for a permit to install plumbing
J 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 of Premises
Owner �/�f��1Pl� �f O 6'%T Address ���� '�'�✓7r Ap
By �J G�� rG''t �A�j3 l u�t Address
4CONTRACTOR, AGENT ` I
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Phone-L' i ` 1 V2 C^ _ Approved
PLUMBING NSP CTORv
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