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c No. Street Lot No. 1;72—
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v LIGATION FOR PLUMBING PERMIT
E ell � CITY OF CUPERTINO `� uNiTf
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Sanitary No.
,1 NOV 3 19 19�� Permit No.
0 RTINO Fee $ 1Si
3 CITE Ikat' Q
s p ion re y 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
S'E laws applicable thereto.
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Use of Premises
Owner PcJEQ--/ c.orJ5r. C... Address
By 3kJ JOSEt'1EL(a'Tv+�u.DA- Ira C,.
Contractor, Agent
Phone Z-IS-c1oJW
State License 1.64 aa-% i
Address I (AS e.,"R& AVE SJ
0
L Approved
,\ P rmbing Inspector