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JUN 18 fjf LICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
P A, 1 D Sanitary No.
Date )-h fvY 20 1921 Permit No S
Pee $ o2-�at
Application is hereby 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 Premises P EC-R.W-Jv 7"10 )3 +� G -
Owner AV ZF z- Y Co w s a—.
By SJpIV .7-05.F Y7„EGt.40—nL Address / 65— r%ZOGE'RS AvK
CONTRACTOR, AGENT
Phone 90 !L4-
State
4
State License
6'.f -71
Approved_
C�
PLUMBING INSPECTOR
Dish I
Waste
Size
Comb.Sink &
Dental Unit
Sink
Cl I.
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