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FOR PLUMBING PERMIT
OF CUPERTINO
Sanitary No.
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19V -7o Permit No.
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�TY'attorTis QUbryCtHTJNlttte 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 Premises 71axtill iI!'t
17 il—
Owner 61E6
By u t1;, T d 1- -Ll ►'k ( vC.
CONTRACTOR, AGENT
Phone �—? G 1.1 �'
aoState License—�
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3Sy— 2 �
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Address 4—
Approved_ of /
PLUMBING INSPECTOR ✓
FIXTURES
I Units I Fees 11 1 Units I Fees
Comb.Sin' & Tray To Curb
Dental Unit
Fee
Permit Fee Y 00
Total Tota] Fee d Q C"O