51226c No. Street Lot No.
.Z CITY OF CUPERTINO
/D/%
a J U L 21 1971
APPLICATIONCITY OF CUPER PLUMBING PERMIT
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°
N P' D Sanitary No.
c
.E Date , 19// Permit No. S/ad's
3 Fee S,3•
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 M, in accordance with the provisions of the um Ing Code of the City of Cupertino, and all other
1.2 laws applicable thereto.
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ro .� Use of Premise r
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Owner Addres
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o By 619 Address
3 t Contract gent
° Phone �
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State License Approved
IY Plumbing Inspector i
Water Heater
Wash