1065 kZS 3 LOT NO
NO. « _
® R PLUMBING PERMIT
•l FEB 9 19h�izy�cuP>xrnvo
Date CITY OF CUPERfi1 0 Permit No. `06.�
Fee$In
(r• S
Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of,the,Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
8 Use of Premises
'a
Owner Hy" Address
gy \r n . VA911L Address
CONTRACTOR, AGENT ITl
Phone Approve it,�
. PLUMBING INSPECiO
El
00 \ � \ \ } \ �
� ° �^ \ : � � \ oq 6-1
01
gw
k No �
on
% : ƒ
Rr