2191 (2) / {� J G�L.LL�L Lt�t r �/J • LOT NO. _
NO. -STREET_
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APPLICATION FOR PLUMBING PERMIT
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VIJ L 10 963 111 OF CUPERTINO �
. M U1 Date ` 15t 3 Permit No.
1 CITY OF C PERT "
Fee $
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� i������� q
Owner_ ?/. � 6r Address �—
O
KEN'$ysnor IAIATon interni Address
202 MATTS* "GENT
LOAMApproved
• V , PLU G INSPECTOR
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