NO PERMIT NUMBERNo. Street Lot No. _Z 0
APPLICATION FOR PLUMBING PERMIT
Y O RT
Date �— FL I okT 9968' J W it Permit No.
�"�'- Fee $ JZ
Application is hereby made tcm" T ylatup��Q p( emit to install plumbing pipes
and/or fixtures listed on the re s c Nereof,ly{cJ e}� o�I said prices and/or fixtures
in accordance with the provisions of the Plumbing Code o the i y of Cupertino, and all other
laws applicable thereto.
Use of
Owner
By Z
Phone
0
State License / / b / 7
Address /3-,S7t/ ') - c�
Inspector
Dish Washer
Size
Water
Fee
.6-o
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