51001.33 r
No. Street
�PP.ITITY FOR PLUMBING PERMIT
CITY OF CUPERTINO
17 2 IQCQ Sanitary No.
t.
Lot No. L�
Date , 196L Permit No.'S /d o /• 3
0.17v nFQ11PERT�el(� Fee $ 0 .(r�
Application is hereby made olthe 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 Premises
Owneri) _!� /—/� .a.� 4--", • �4i7 ;
Contractor, Agent
Phone X93 - F0217
State License R %% 1
X
Address / KO -:_.Cl
Address,<'I-,, 3
Approved -1010'
Plumbing Inspector
Dish Washer
Machine
Total
NUMBER
SYSTEM