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OF CUPERTINO
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Date NOY J
19611 95— Permit No.
CC
CITY OF F[�T ���
Ce vypl. h'tIW Fee $
Application is her y 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
g� Cupertino, and a(rmQ
aws applicable theret
Use of Premises Rel 3 - L
Owner tldiess h
/ yt
By )C -� Address .
CONTRACTOR, AGENT t ? '
I Phone X Approve'
PLUMBING INSPE OR
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