1751 (2) 1) 1 � ��j w LOT NO
NO. BE41
® APPLTI0114FOR PLUM91NG PERMIT
AUG 7" 1962 1sOF'CUPERTINO
DateCST _ 't9t-2 Permit No.
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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,&de of the City of
Cupertino, and all'other laws applicable thereto.
u Use of Premises
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Owner A4. Address
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_ Address
Rsnv a ,U�CONTAACTOR',`AGENR T 1`
Phone f' • +•' "'{ Approved
ti PLUMBING INSPECTOR
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