930 (2) DNn �� 'A I N FOR PLUMBING PERMIT
L�1OCT 7 I 0 TY OF CUPERTINO
Date195_ Permit No.
CIT�CUPE- TI 0 ,
t Fee $ `i]
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
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Owner co 1 i 1 z c �, Address
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By k � I Address � V
NTRACT R, AGENT
i PhonP'�O '�� APPS e h'
L PLU ING INSPE TOR ,/ '
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