51182Y7 �.I� of f��?/
Lor No. , �J
No. STREE.I' 0,00/
APPLICAIIQN FOR PLUMBING PERMIT Y�
— � vy No. D OT 9
Date //B2Gix�ee/e2%Df� 196! P.la it No
On/Fee S 9. D
Application is hereb}' m, gfthe), of Cupertirid for a permit to install plumbing
pipes and/or fixtures listed on the We a e�. ereof, and agrees to install said prices
and/or fixtures in accordance with the prove i6 �(7fjthe Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
Owner _ ttCLGG1L'/J �/
By. ra.�L 0 G .
CONTRACTOR, A NT
Phone
State License
Address �� items
Address
Approved WILLIAM n
X PLUMBING INSPECTOR
Water Heater
Wash
Material
To Curb
WA
Water Sys. Fee
U