100139 (4) ICOT NO.
NO. TREET
P TION FOR PLUMBING PERMIT
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° /ASanitary No.
Y �1G �' 1969 ,/ay_, X39
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3 a I. ate 19G— Permit No
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° �I�Iilic� in � T, 4 the City of Cupertino for a permit to install plumbing
o pipes and/oi fixtures is ed ) he reverse side hereof, and agrees to install Said prices
r and/or hxlUres in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and allother laws • p)licable thereto.
Use of Premises
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By Address
J 0 CONTRACTOR, AGTeNT
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�T State License Approv
�3— PLUMBING INSPECTOR
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