2081 (2)' /9y76 /e) f/.Nc/ LOT NO.
NO. srasrr
APPLICATION FOR PLUMBING PERMIT
W CITY OF,CUPERTINO
LL � a Sanitary No _.
3 <Date 1961 Permit No o
X W F I . ree$ 3S`4
O Application is hereby made to the City of Cupertino for a permit to install plumbing
o° pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i m` and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
4 , Cupertino, and all otherlaws applicable
thereto.
J LL Use of Premises r
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3 Owner 7—h 0,4v A5 W' /of d/76+ c, .Address
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BYSlot rke A/1 3, P/� Address. 4 it yG A v
3: PCONTRA&OR,AGBNT
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ioto License I Approved
- r � PLUMBING INSPECTOR
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