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LOT NO.
NO. STREET- va
. .OkPPLICATI6.1 FOR PLUMBING PERMIT
W — r`. is oC '96� C T1'�OF CUPERTINO
rc Sanitary
M 11
i Date WWI O'I f! 6 Permit No l� J
A —
11L jr` : " ' ree S
`• a W Application is hereby made to the City of Cupertino for a permit to install plumbing
o `s pipes and/or fixtures listedton the reverse side hereof, and agrees to install said prices
i 1- and/or fixtures in actor ce with the provisions of the Plumbing Code of the City. of
Wli Cupertino, and all o er'Is s applicable a o.o
Wr
o�o Use of Premises—
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< o State Li /1L • Approved
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