51177.1�/ I —v LOT
NO. sTIUnEl
CITY OF CUPERTINO
wCny of cups%YPPLICATION FOR PLUMBING PERMIT
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� Apllication is hereby made to the Cit}' of Cupertino for a permit to install plumbing
o < pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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�. Use of Premises �.eT L!J/JWM/NG Opt_
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3 Owner _ A9/OSSOV Address /9-"S BEvNE77 / �T
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;o By ✓191 CulTorh Cos-7om-But�-r Address1003 NAAA1011L16 111
3 O CONTRACTOR,AGENT PooA
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aState License. oiSl-39 Approved'
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r PLUMBING INSPECTOR /
Heater
Wash Trav I 1 II STORM DRAINAGE
Comb.Sink & Tray To Curb
Dental Unit
Sink
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