2626II
.LOT NO. /
-PLUMBING PERMIT
CUPERTINO
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Sanitary No.
GA .
Date MY 9-RERTiNA?/-- Permit No 0
O
Pee $ G /
Application is hereby made to the City of Cupertino for a permit to install p um ng
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
Owner ti �� Address
By Address
CONTRACTOR, AGENT
Phone -5 — -2 3 —D 3
State Licens 6 S Approved
Aoa
PLUMBING INSPECTOR
Water Heater
rinkler Varves
NO
M
Boxes
Fee
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