1811 (2) —F/P—EGd/A,eT e LOT NO.
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D �A FOR PLUMBING PERMIT
o� ry 2 1 ,pQ2 OF CUPERTINO
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IOCT . 96
Date c L 195_ Permit No. �.Ob
CITY OF Fee $�C-0m
(� Application is hereby made to the City of Cupertino for a permit to install plumbing
�p 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 Code of the City of
Cupertino, and all other laws applicable thereto.
u Use of Premises �ESil�eEyc%
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By CAi!WM. Lo Address / tJ
CONTRACTO , AGENT
Phone 13�0�2�0'�L . Approve
PLUMBING INS' 6T
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