51129/0,5-4 13AY400 b) CT
No. Street
Lot No.
Cff OF CBPERFIPQ APPLICATION FOR PLUMBING PERMIT
EATER DEPY: CITY OF CUPERTINO
. „ 1 10 1971
1
DateIr ne. �4 n I -S 11
Sanitary No.
Permit No.y.S
Fee $
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
Owner 4,L,)
/ L
S ti S,
Address ,T.4 /-r r
By 4,::r
LrG
L(/
Address O< -w it Yh ou-Nv V/T
Contractor,
Agent
Phone 29
%
9 /Q %
State License
23
7 (7 00
Approved
Plumbing Inspector
Water Heater
Waste
Water Softener
Comb.Sink & Tray I I II To Curb
Dental Unit
Size
I I II Permit Fee I l e o
Total Total Fee 3,.9=•