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12P TION FOR PLUMBING PERMIT
CITY OF CUPERTINO
�Ci. 2 1970 Sanitary No.
pie �19 Permit No.' // a 7,
Fee $_-
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. I
Use of Premises
.^Z
Owner ">Z5 +`.7L'—'t—T Y WOOQE-Address
BY Y3tvp�.gory � t���L..
Contractor, Agent
Phone Q —1!!s--7
State License /
Address -SC -42/4 =uc-.so"A
ApprovedJILLZf ZA D. 13,3N-!yicH
Plumbing Inspector
Washer
To Curb
Floor Drain