1303 �J
Q2 e 1,9 9 o I.Nt. LOT NO. _
NO. L4
��1A1 ICTibN FOR PLUMBING PERMIT
'Gg�3IT$OF CUPERTINO
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Date--t "" 19$.� Permit No. 30.3
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Application'is.he�reby made to the City of Cupertino for a permit to install plumbing
pipes and/or.fiatu' ,res listed on the reverse side hereof, and agrees to install said prices
and/,or fixtur5"scin,&5cordance with the provisions of the Plumbing Code of the City of
Cupertino, and,all other laws applicable the to. w
. Use of Premises
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Owner �ta��'1 ��Addres /
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By ' Address
,o C N CTOR AGENT
1 " Phone ` - Approved
• ?4UMBI INSPECTOR
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