1793 ' C ,,I,, �• -' \ LOT NO.
®NGG� "7l'PPA 1� FOR PLUMBING PERMIT
P 1I8 Z OF CUPERTINO �J
Dat ' 190— Permit No.
C1 Fee
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.
I
�= Use of Premises_
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Owner •Address
By' Address 7
r. ' CONTRACTOR, AGEN
Phonel�. ._61�_ _ ,.Approve
)401-07 PLUMBING INSPECT
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