51179.1101(00 MELL0 PLAt:P—
No. Street
0
APPL s0' P IT
ttYY T OF CUPERTI i
IOCT 28 19%ani No.
Lot No. 72-
Date
Z
Date 196 1 Permit NoC®i /"
fTY-OF CUPERTINO Fee $44
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. 1
Use of Premises
ownerNa Ma -5 6R2y S_ R 12a'ir
Byd. c:74-9 "�'`'�"—� Address
Contractor, Agent
Phone -73Z —3400 X' Sl9
State License Approved
I
Wash
Comb.Sink &
Dental Unit
Water Sys. Fee
CITY OF CUPERTINO
10300 Torre Ave.
. f, z '*
CORRECTION NOT , ICE
..........
Job Located
l---------------------------
You are hereby notified that no more work shall be
done until the above violations are corrected. When
corrections have been made call the ippfletor.
252-4505
City Telephone
Date: