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52301 (2) No. sTRFP.T'
CITY OF CUPERTINO /S 0 do
Lw of PLICATION FOR PLUMBING PERMIT s�
r o MAR 21 1972 Sanitary No.
a 1):Itr 19 — Permit No f 1-2-3 U•
UT
i o A Pec $�L S
Application is hereby made to the City of Cupertino for a permit to install plumbing
'o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
'zand/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
a
0 w Use of Premises
00
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, 3 Owner-L��//l/� �/�rr�/l�/O fMddress
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� z riy_ /fyi'/SF-�✓pCIJS Address �F'>.G�fC�U
CONTRACTOR, AGENT
3 < Phone_;75
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a o /State License ;91�—��t ,5r9 Approved
- U PLUMBING INSPECTOR
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