1168 p5 � /NO. 27-1 �T "a&, LOT NO.
P4 6ATION FOR PLUMBING PERMIT(��053�
QI OF CUPERTINO
DaJill grq, iMIlrylU'1 195_ Permit No. r'
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ikatibhris tO4r11eUTIPPe 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
Q'n
� and/or fixtures In accordance with the provisions of the Plumbing Code of the City o
gd Cupertino, and all other laws applicable thereto
a . 't
V Use of Premises - --c=4.L— L [_
Own 'ter )� �r Address
By !er/ ,,4 114-0-1/ti' Address
CONTRACTOR,
AGENT I
�1Phone S`�Y7 _ Approve
A�
'jf tl PLUMBING INSPECTOR
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