1347 dOO bJ PLCPPC/� 1G'. L/`IN� LOT NO.
No AP SktC F PLUMBING PERMIT
4� N OV 3 0 1 U UPERTINO
Date nlnl/. �d5• - t9 Permit No. IS / '
CITY OF CUPER1041"' . Fee $ F—
Application is hereby made to the City'of Cupertino for"a.permit'tol 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 Z'
Cupertino, and all other laws applicable thereto.
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Use of Premises .S 6 F T W/9 7 R SFl?VlG
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A. N Owner_WW13RD GRRD«Y Address v
t� By RAYNE SaFT hIo? FP SfRV16E 1 Address }
(� CONTBACTOa,.AGENT ,
}1 i T[// q'hone �Qd< 1 7—6 6 n 9I
Approved
r1` , f1\/� PLUMBING IN EC OR
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