51189 (17) pftiro.li 1 Street = � Lot Nu. Z Z
rJWIM14 PION FOR APPLIANCE PERMIT
n City of Cupertino 57//9?
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o IAN 15 1g7a9 Permit Fee
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$ ro s ae tee , City of Cupertino for a ponnit to install Sea appliances us
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and epees to install said appliances in accordance with the
`o u provisions of the Plumbing Code of the City of Cupertino, and all other laws applicable
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thereto.
Use of Premises
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Owner , Addles
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a Ey .e WY Address
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.. State License�a3� /y ��°C.clSpprore
l16mbing Inspector �/
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