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FOR PLUMBING PERMIT
Mi Y OF CUPERTINO
ro (JUN 121963/ Sanitary No. •
o a Date `— `7 1963 Permit No C2-151p-
3 LL CITY OF CUPERTINn Pee $ ao ==
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� Application is hereby made to the City oF:Cupertino for a permit to install plumbing
o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said rices
i N and/or fixtures in accordance with the provisions of the Plumbing Code of the Crty of
a w Cupertino, and all other aws applicable thereto.
0 o Use of Premises.2.
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o a ' Owner _ Address QTS
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�� CONTRACTOR,AGENT 17
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� WILLIAM•aState License D. BENEVICo Ft
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y .•;r '> PLUMBING IN$PBCTOR
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