51226 (2)Y71AeazLOT NO.
NO. YrR EEl'
® PCI ON FOR PLUMBING PERMIT
U
® TF OF CUPERTINO
Sanitary No.
Date O /y 196— Permit No .5)?—Z6
��C[ //�� ppTTllpp��nn Pee $ 2 R, 50
CRPYiticUo it.,i�te�yfitlh8NDthe. 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
I CONTRACTOR, AGENT/
Phone 3.7P "y
State License_
Addres
Address /Ph ¢
ApprovedLX
b'
�� PLUMBING INSPECTOR