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`APPLICATION FOR PLUMBING PERMIT
w SEP 9 CITY OF CUP17RTINO
, o C — Sanitary No..
3 a Date n• .r - N.• I'� Permit No �S
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O 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 m 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.
0 o Use of Premises 7 ///� /T ' 7—
o a Owner OssnbS22&lWe 5 Address
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_ o By,�tLyl/l�� Z�— Address
3 r CONTRAC'MR, AGENT
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a o State License-20 �2 _G Approved -C� /110 2
PLUMBING INSPECTOR
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