2191NO. STR00T-
F1.APPLICATION
IJUL 10 963 *
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OF C PER ""
LOT NO.
FOR PLUMBING PERMIT
OF CUPERTINO
1st� Permit No.
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.
Use of Premises�i������� q
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Owner_ ?/. �6r
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KEN'$�nor WATon interni �T
202 MATTS*"GENT
LOSP M S, OAHE
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Address�—
Address
Approved
PW G INSPECTOR
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