51002/03a2 I r7 L P/.(/f' D14c LOT NO. /
NO. STREET'
CITY OF CUPERTINO
z <PLICATION FOR PLUMBING PER IT / �?
f a Clif 10 PcRl O Sanity ry i\'i�. 7& 7/
o t 7
° J U. ) 2 19 /� Permit IVo
3 U Pee $
iwj�
o ARIAorf isareby made to the City of Cupertino for a permit to install Plumbing'
o < pipes `d/or fixtures listed on the reverse side
anhereof, and agrees to install said prices
> I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
wi
� w Use of Premises
00
3 Owner'(/I1PFieAddress
OJ /r i
J z By /C/— i�/� fs S Address X /Q i L
O CONTRACTOR, AGENT
3.Za 5 - 9iG o
— z Phone
w z
oState License "1 % S� °� L( Approve
U — l
�J PLUMBING INSPECTOR \
Size
Dish Washer
Water Softener
Comb.Sink & Tray I 1 II To Curb I I
Floor
Size
Water Sys. Fee
Total I 1 11 Total Fee 1 .S 6 —C A