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... NO. f STB6ST A
AAPCIC 'TIO FOR PLUMBING PERMIT
1 I,OF CUPERTINO
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Date 19fi ) Permit No. XG
' � Y OF UPER7Ii�G Fee$ o— �
Application is hereby made to the City of Cupertino for a permit to install plumbing
v pipes and/or fixtures listed on the reverse side hereof, and agrees.to install said prices
Q and/or fixtures in-,accordance with the provisions of the Plumbing Code b(the City of
Cupertino, and all other laws applicable thereto.
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Use of Premises AA.X 4' -�t./iq-4
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Owner ). y,Orel ym ioi Rr14 Addrq °A EWSAVE
oft' Address? �� �d i.0+ CONTAACTO�AGENT
Approved S4JJ
�. PLUMBING INSPECTOR
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