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APR 1 19 PPLICATION FOR PLUMBING PERMIT
11 CITY OF CUPERTINO
Sanitary N o.
2-zi�te� � � �9' Permit No
Pee S 5 12
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
Owner S/ZAll /"1 N• Address SSM
By /A—t RACx � Address,396 6&7ZAY/Te, 7 by "V,i
Phone 2-q-?—Y,/o7
State License 2 37 9 O.?
Approved
PLUMBING INSPECTOR
FIXTURES INUMBER 11 MAIN DRAIN
Units Fees Units Fees
Water Heater / /u Size / ✓_
Machine
To Curb
Water Sys. Fee
Total