2701LOT NO. • 1 _
NO. TRE T
O FOR PLUMBING PERMIT
C;iOF CUPFRTINO
VIAPR 17 1964 t""". ��I��I1��1� i Sanitary No.—.—
Date
u. —Date 4� , 196`/ Permit No o/
U Y OF CUPER7 `.',; Fee $ wn
lo
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 /f�si�l/ems
Owner /%UG U' FG-LlOY
By 20& fJifA, ,'91 'OZZ'19i31A/G
CONTRACTOR, AGENT
Addressly/,13'iUG(i//(HFS
Phone
State Licens Approved
PLUMBING INSPECTOR
Heater
Its
rea
Z /--4" ,"
UNITS] FEES
Sprinkler VLu,cs I 1 11 Water Sys. Fee I/,,lo
OF
ain Drain