NO PERMIT NUMBER/0.2-oS—
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W
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No. Street
APPLICATI(N1,EQR PLUMBING PERMIT
CITY_OF�CUIN� ;,,
Samtary No.
(� 7 1968 W
Date -6z' /E�1.�5c'" - 1�I96Vil'� Permit
i
Lot No.
Fee $
'S • r 1. /�
Application is hereby made !IT\ the city 2�u Mu oThor >vpermit to install plumbing pipes
and/or fixtures listed on the reverse sde heie0 anllr agrees o 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
By
Contractor, Agent '
Phone ?F44tr—4-1,1711
State License 22 03� Z
Address/020S 'Qt/o �iJLJo
.fro �o
WILLIAPA D. :=Nyle
Approved
Plumbing Inspector
MAIN
Water Softener
Combink & Tray �� To Curb
Dental Unit
Sink
Water
Oy