1568 (2) �ll / Ir- ��/ �-
0T NO.
NO. sla ifIv
® PL4 1[04:,FOR PLUMBING PERMIT
yF
I - OF CUPERTINO
rmAy 2'4 1962 i
Date 93_ Permit No. J S�
CITY OF CUPERTINO Fee $/S
'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
I, and/or fixtures in accordance with the provisions of the Plumbing.Code of the City of
Cupertino, and all other laws applicable thereto.
+i Use;of Premises— -,2,&
Owner f// /C • /r�t+�C/�� Address
=3•i �4'. Z (Ck
.gy t. .y'.SIaFF VVAYER �` _ Address
rr.;+
Ph
I L4("CONTRACTOA, AGHNT +t i
A roved
'( �' 4{',';v-ry /mow; PLOMBING INSPECT A
F,
> ma : 9> xxhf dOc� m � .der, r � � �w
o o
B ❑ m 0. N w. :n
� In
O .s .,• �rf `E. Z z
PU
b r. r • N y
N
Cn
.� 0
o
Kf