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1284 LOT NO. NO. STREET FpR PLUMBING PERMIT VOCT 2 ��s� TYOF CiJPERTINO D 195_ Permit No. /-2 CITY OF CUPERTINO Fee $ 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 and/or fixtures in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all otherI applicab the to. Use of Premises Q Owner 7Vo_ Address By A91k A �/� � CONTRACTOR, AGENT Phone-AL -O _ Approved PLI MBING INSPECTOR w�I 'a y0 <. :� > w H C x m u uIv Wo �7i y 1� .1�a h � [rl C ———————— ----------- ----------——._ z ———`————— —— [*1 Q ro w .��. 9 OH OH n <n 0 0 0 0 ^y nK ---- N I, the undersigned do hereby cc till that I am the owner ark occupant of the �sin�le f mi y d olling at i for which I am making application to do work as a home owner. so certify that I '11 not hire any non licensed or contractor, but will do this work myself. TKLEPLOjvE ,jU14BLi7 1A7URE