2263 J _� �L LOT NO. �
NO. STR RF{�•
N �4-PhICATIbN FOR PLUMBING PERMIT
w i FUL
'.ITY OP CUPERTINO
p 2 963 I Sanitary Nu..
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° a Date 196.5 Permit No
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a CITY OF ma e to CUPEgTI.�TC Fee $
w w Application is hereby the City of Cupertino for a penult to install plumbing
o 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/la/ws applicable thereto.
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0 o Use of Premises
oa Owner /1_p/39.C>f /�<<.yls j Address
° Y Address r0' AX lJe I&
�/CONTRACT R,AGENT
3 Phone r/� ���� !d' .! }d � //
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o State Licensq'z"> —d.l IF Approved
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PLUMBING INSPECTOR
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