1072 LOT NO.
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APPLICA 1 R PLUMBING PERMIT
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Dat U91i21 Permit No.Ur uurLn
11JJ Fee$-47 ,
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.
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