51008 /033/ le-e 47 C / LOT NO.
NO STREET
CITY OF CUPERTINO
APPLICATION FOR PLUMBING PERMIT
CiY of CUPERTINO
f ��1 QJ7a Sanitary No.
Date` = l ,19—z / Permit No.
Fees 3�
Flop
yWibn "ereby 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.
Use of Work To Be
Premises ,/ / ,/� / Performed
Owner )'y A r o/ Fi9 i'P &6 / /Iddress
Phone
By
—� Contracloq Agent
Phone L3\B��` � 2=
h,C g/ roved
State License A PP Plumbing InspOctor
I1 I AGREE I WILL NOT VIOLATE ANY OF THE WORKMEN'S
�`�-- COMPENSATION LAWS OF THE STATE OF CALIFORNIA.
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