2079 NO. .STREET'
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPGRTINO
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$ Date ��' 196 Permit No.
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0 Application is 4ereb'y-made40 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. y�
.. Use of Premises 7 G Its/ 7"' p4
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r 3 Ownerr )OA-ll h 19/1 A) 1, Address
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j r CO2tyTRACTORf-AGENT
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Vte License Approv qdj 'C--
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PLUMBING INSPECTOR
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