2454 ET tOCTAPPLICATI
LOT NO.
FOR PLUMBING PERMIT
4 99&3 OF CUPERTWO
o Sanitary No.
3nnJl "( Permit No
iFee $
o Application is hereby made to the City of Cupertino for a permit to install plumbing
o pipes and/or fixtures listed on thereverseside hereof, and agrees to install said prices
i N and/or fixtures in dance with the provisions of the Plumbing Code of the City of
a w Cupertino, and al other laws applicarbl e o.
LL Use of Pre .
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u iState Liceas'/ t`I` � '•APProved J O 15.4 t
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