12052 c�
NO. i STREP.I' o.
N APPLIC14T1�N FOR PLUMBI PERMIT
z 1� CITY OF CUP17RTINO
w �r� o a/
x oD � N! � Sanitary No.
3 RLL �� � qnc, VVVVVVVV�. �no�'�.
a Dat i { u+ 196— Permit No
U
i a Pee $
° A>> cati4qRqris hcmh�5i!ad� tolthe City of Cupertino for a permit to install Plumbing
o piln /oi;J6ztu4dS�IksPed ori'tlie reverse side hereof, and agrees to install said prices
itn an orxtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
w x
~0 t Use of Premises
00
oa Owner--C. I ` Address
Z J / NT O T
z By � fd Dn fJ 1v/ �A Address
� ✓ C RAC70A,AG•N7
3 �
w Z Phone
rc a
a o State License IC/D/3Q� APProv
—
U LUM 1 G N •
J C H
s m G
r n0 Z
� m
y
Wz l
� n
J
m ? Z z
�� ' m m