1105 ao9yo PrFara TREL� L,IN L-'" � LOT NO.
No. STR�EET,,
'n P L CA TON FOR PLUMBING PERMIT - •
Ra ,_ OF CUPERTINO r;
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1APR 17 1961
Date 195_. Permit No. J f 0
CITY." OF' CUPERTINO Fee $
=,•h 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
is
11-a and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
V Cupertino, and all other laws applicable thereto.
s
Use of PremisesL•W6ZN
• Owner 40mmjwwknArq RL4�Ra Address
By P11AA P,4t,MPi"4 Address
i CONTRACTOR, AGENT /
Phone ' FR=i�!— P/// Approve�iw�`
" ++ PLUM BG rl SPECTOR ,
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NOTICE. OF ADDITIONAL CHARGE:
YcCJ -RTINO
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OFFICE
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.Cipertino Sanitary
Office Copy
BUILDING..:INSPECTOR'S OFFICE .
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CITY OF CUPERTINO iF,• -
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�Plumbing;,Pinad'O - ,.Plumbing, Peimit ,No.,_: f -
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S' 3 UAfBINC INSPEC'COR
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