51177.1 (2)a No. Street
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d F� APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
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ySanitary No
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E fate 19�
Lot No.� /
Permit Nd Z % 1
3 CITY afc CUPERG NO Fee $�_
m pli on the City of Cupertino for a permit [o install plumbing pipes
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
c .E laws applicable thereto. p
o
.� Use of Premises
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Owner
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By
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Contractor,
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'Agent
Phone1 — 7
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State License
Address
Approve ILLIAM D. BENEVICH
Plumbing Inspector
Water Heater
Wash Trav I 1 II STORM DRAINAGE
Water
Comb.Sink &
Dental Unit
Material
Water
Total