51009 - P / y �ea(e& 6474- LOT NO.
NO STREET
CITY OF CUPERTINO
f :APPLICATION FOR PLUMBING PERMIT
�r �, 2 l� 1979 Sonita,YNo.
Date /� _"�Lf ,19—zy Permit No.
Fees X55'Q
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 pipes
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 Work To Be 2
Premises Performed ✓/7/r`'/j- Gr C(S' n7Qf �/�
Owner �» 09 Address 3 TV Leol 0—f-
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Phone / '
BY�1j]fJ,�[/��(�(2212 Address
Contractor,Agent
Phone J7 jfV—/'�27s—
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State License `� �Q Approved �" ' -�� '�"""�—'�' /—
Plumbing Inspector
I AGREE I WILL NOT VIOLATE ANY OF THE WORKMEN'S
�✓ COMPENSATION LAWS OF THE STATE OF CALIFORNIA.
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