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FOR PLUMBING PERMIT
CITY OP CUPFRTINO
3Sanitary No.' AUG 21 196 3 a Date 1969 Permit No,
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LL C,TY OF 'IIPERT'" Pee $ / d
0 Application is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i N and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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LL Use of Premises ,Dll r!`&e c o
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of Owner (.MQQm(I c(�irv�jr P Address ///////// pA�AA�+ Ir'
o By i�llA! Q Address
r- -CONTRACTOR, AGENT
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ao State License O? _ Approved
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// PLUMBING INSPECTOR
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