51128No. Street Lot No.
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H CRY OF CU►ERrINO
u APPLICATION FOR PLUMBING PERMIT
E MAR 2 6 1911 CITY OF CUPERTINO
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HSanitary No!
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E EDatA B flk / y
/ , 19av / Permit No.
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3 Fee $ 'O
Y 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
0 „ in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other
'E laws applicable thereto.
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A A Use of Premises
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° Owner +�6F2 �y Address/n"y0a /.4¢/%4/1/4 /iV
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By /t/ A, ✓GtEf 1aLijr Address %15s� OA37LA/✓�
3 L°. Contractor, Agent
0 ° Phone ;14s - 1791
—I, -t State License %S / �Y Approved
}}— lumbing Inspector ✓
Fees
Water Heater I 1 II Size I I
Waste
Material
_ Comb.Sink & Tray To Curb
Dental Unit
Size
Water Sys. Fee
i II Permit Fee
i
Total ii Total Fee