2713 Io? I lt/LJ "Cz'� " LOT NO, A9
NO. / ST EEI'
PL CATION FOR PLUMBING PERMIT
Z a ® �� 'rY'OF CUPP.RTINO
o gnrn q j Sanitary Nu. _
196 Permit No
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Pee $
,q� ¢Q[J yi[ue t4 the City of Cupertino for a permit to install plumbing
`o a pi fies� InH/o4rhxtutiste8`on the reverse side hereof, and agrees to instal
i m and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
< w Cupertino, and all other laws applicable thereto.
.. Use of Premises
00
, 3 Owne /� Address-/c S.f9.9T.yii.OfJ_���nrr 04
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Address •CJ. /SD �: �
CONTRACTOR,AGENT '
— < Phone. 5246
W Z
ao State License Approved
—U PLUMd1NGI�SPECfp�R
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