2627LOT NO.
FPPLICA i 1J¢�,1'�yFl(jOR PLUMBING PERMIT
INAR 4' 1964`lG�7F CUPF.RTINO
Sanitary Na.
Date '1 }� Permit No
�l�Uf uvo Pee
C
Application is hereby made to the 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
fixtures in accordance with the provisions of the Plumbing Code of the City oC
Cupertino, and all other laws applicable thereto.
Use of Premises
Owner-Q - � Address
By 'e-e ' 4—t"'' Address
CONTRACTOR, AGENT
Phony .42q-I _-;) 3 � 3
State License ��^ 5-;7 q Approved
PLUMBING INSPECTOR
UNITS I FEES
ullrQ
Storm Drain Fee
c
Sprfnkirr Vaives I 1 11 Water Sys. Fee I / �
I
OF