2249 (4)LOT NO.
NO. STREET
APPLICATION FOR PI ' RING
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CITY OF CUPERTINO
PERMIT
Sanitary No.
Date — , 1969 Permit No /I"•� T
y Pee $
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 Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises Zp/T
Owner,T�Gly1iY.S j�/l'lo/sfyt
By
CONTRACTOR, AGENT
Phony ��%Fi�i .� 1
State License jQ 7-T
Address -'/-?0— "Sox`5
i
Appy
PLUMBING^ INSPECTOR
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