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No. Street Lot No.
o —
A
APPLICATION FOR PLUMBING PERMIT
E CITY OF CUPERTINO
Sanitary No. r
Y Date ,1 196_ Permit No. J O
3 A l •� Fee S,
Application is hereby made to the City of Cupertino for a permit to install plumbing pipes
w and/or fixtures listed on the reverse side hereof, and agrees to install said prices and/or fixtures
o in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other
="P laws applicable thereto.
" o
„ G Use of Premises
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o Owner is GEE / rOy RL(JE Address
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A
ti By Address
3 s Contractor, Agent
°' ° Phone /�/��/ye5
A 3 ( ff/! -2. 7
m.
-a LState License Approved
{ 1 Plumbing Inspector
Fees
Dish Washer
Comb.Sink & Tray I 1 II To Curb I I
Unit
Floor Drain �� WA'
Hoover Size
Total Fee