100242O � \ I U 6 ^ �'� LOT NO
NO. STIF.F.I'
CITY OF CUPERTINO
" < art OF cuFEA"LICATION FOR PLUMBING PERMIT
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x °OCT sanitary No
4 15 1971
o J Date 19 _ Permit No
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Apphcahon a hereby made to the City of Cupertino for a Permit In 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 PlumbCode of the City of
a w Cupertino, and allher laws applicable t�eto.
a ~ Use of Premises VRC
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0 3 Owner ^ "w
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3 CONTRACTOR, AGENT
-m Phone �?S --�-L-60{�
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a2 State License. C%.Wh
Address n _
Address G A %smye
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UMBI G INSPECTOR L'
Size
Waste
STORM
To Curb
Dental Unit
Size
Water
Total