5103810336 F/9RJ)Q-0SC pts.
No. Street
0
A AT
ION FOR PLUMBING PERMIT
CITY OF CUPERTINO
E
o
(,NOV 9 1970 YYY Sanitary No
E Date— .19-1d
Lot No.
Permit No. .�—/O f 9
3 CITY OF CUPS INO Fees 3,5-0
v 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
o in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other
c laws applicable thereto. �-
A Use of Premises Q-d',n (�-S �. INE LD/ Z/GAS% -)
p U �
° Owner d. 0EiIIE Address/033° EARALLdNE DR.
O
c is
Byit GI N L-2 - Address
3 ontractor, Agent
° Phone 9
kState License Approved
�% Plumbing Inspector
MAIN
Size
Floor Drain .I 1 II WATER SYSTEM
0
Total Fee