1570 (2) LOT NO.
NO. ST
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ON FOR PLUMBING PERMIT
® CI OF-CUPERTINO
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Date 95_ Permit No. /� 7U
' .Fee $
Appffi ilereUy l� tb13lttctx.oftiCuperti do:f_or-a permit to install plumbing
pipes and/or fixtures listed on the reverse side hereof,and 'agrees to install said prices
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and/or fixtures in accordance with,the pro6isions.of;theiPlubing�Code of the City of
i \ Cupertino, and all other laws applicable thereto.
8 -.'Use of::Premises
'Owner% Address
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gy`bilr+r_e� SbrT V`JQTE4t SERVICE'• ' Address„9 �V �CONTRACTOf ti`GENT]- i
(' Phone �'— APProved
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