1377 (2) i
6) C) �U IJ rLI S L� � •� LOT NO.
NO. STaBBT
PLTION FOR PLUMBING PERMIT
OF CUPERTINO
/p�
Date QAN atQA2195_ Permit No.-.-._.. ./_.
CITY,, r py p�� Fee $ b 1
App icationis H���h1a8�111�fhe City of Cupertino for a permit to install plumbing
a; 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 f the City of
}' Cupertino, and allo laws applicable thereto.
!r 1 Use of Premises K o
?�I N Owne ' ar, J �S FIR J l$ Address
+i By aqy' ` f W 6G dMkk Address
AL , AG
EW
_ x. _ Approved
PLUMBING INSPBCTQa
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