2292 (2) /f7./ J I �.Li C-(ifJ{ LOT NO.
NO. -� MEET
APPLICAC)BN FOR PLUMBING PERMIT
' CITY OF CUPERTINO
t�Date V',17 194�� Permit No.
Fee $
�J— U Application is hereby made to the City of Cupertino for a permit to install plumbing
b pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
TA 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 ���r�LI�Y�-�C
2 Owner a4»�iYr� �' Address
KtA'S SOBY ': nrrn _ Address
202 MATTSON HVCIVUG�OR,AGENT
!.OS GA;Pjhone _. Approved
r. J10 Z-- XMUNI INSPECTOR
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