1752 I) / / YA to11�-r {.-C�✓VV-� LOT NO. ,
NoVA .PLIG{YTJQNtF,-0R PLUMBING PERMIT '
b•+ A 7 196`� p CUPERTINO .
Y .
Date 4z Permit No."��
CITf 61F GUPERTINO .Fee $_/s/
`7 Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes and%orf fureL listed on the reverse side hereof, and agrees to install said prices
and/or4E xturesii'Vaaordance with the provisions of the Plumbing.Code`of the City of
\ Cupertino; and all''other laws applicable
� - thereto.
Use of Premises''
'Owner, z d��`GTi rC Address
By Address � _
�• CONTRACTOR, AGENT, �- •• i '
: . -sr;4., A rove / . t f
Pho
ne _ PP
_ r i PLUMBING INSPECTOR
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z7 0 'wo H a' 9 COlin E
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