NO PERMIT NUMBER (4)c
0
Lot No.
APPLICATION FOR PLUMBING PERMIT
FCUPERTINO
Sanitary No.
Date h f �, %4t8_ Permit No.
v Fee
SO
Application is heretly madeto heOf 4pertino for a permit to install plumbing pipes
and/or fixtures listed on re Ll?( h4Pof; land 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 Premises
Owner F241),e /"' fli/�iYJ•
By f�
I&
AA�
Contractor, Agent
Address
Address ��6/Su9Lir�//7C
CFS?,/otPi GC/. f .
Phone-
State
hone-State License .2 / 5 fO A Approve
Plumbing Inspector
Water
Wash Trav I 1 II STORM DRAINAGE
Comb.Sink &
Dental Unit
Restaurant Sink