51019as Ae3 a.l Cp LOT
NO. STR EF.I'
CITY OF CUPERTINO
APPLICATION FOR PLUMBING PERMIT
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°< Dat - 19
3<2 1971
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Sanitary No.
Permit No�c/O/ q
Fee $ // 60
°Apit�it n fi i hgr by made to the City of Cupertino for a permit to install Plumbing
o a pipes :i*fd/ ores listed on the reverse side hereof, and agrees to install said prices
I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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LL Use of Premises _ �(,(� �i1it...Vl. 'ti A
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3 Owner
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sy�l FP. 75 A4 �aa L S
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CONTRACTOR, AGENT !
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-0 Phone 21%
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KLL �
a n Slate License 7,20-1-3q
Address -�a9 (
Address 9140 J7ii 7941tdwt-,b Rd.4
ApprovedWILL1AM D. EENEVICH
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PLUMBING INSPECTOR
Washing Machine
Water Softener
Fee