1172 LOT NO.
NO. -s EET
p OR PLUMBING PERMIT
6
CI OF CUPERTINO
1AL 2 �9V
Date '2S , 19t1ZL Permit No.
CITY OF CUPERTINO Fees 9
Application is hereby made to the City of Cupertino for a permit to install plumbing
`i% 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 other laws applicable thereto.na
Use of Premises Tea.,
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Owner �I I I�Qex Q Address/071 �£
BY KAddress I t ' u ,A
CONfDiTOR AGENT
,hone /- :2 7 9 r f Approved
^/ PLUMBING INSPECTO
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