51220.21137 I 3 u eg TD. LOT NO.
NO. STREET
CITY OF CUPERTINO
" a APPLICATION FOR PLUMBING PERMIT
�
z
W
Y O bSanitary No.3 < Date L. 197/ Permit No ...' AX20. A
W LL Fee $
x
° Application is hereby made #e�GtCj IMOCupertino for a permit to install plumbing
o pipes and/or fixtures listed 9 the reverse side hereof, and agrees to install said prices
I`- and/or fixtures in accordance v e pr'�3i 1pns of the Plumbing Code of the City of
a w Cupertino, and all ytlatw��hPablc thereto.
w x -A�
a Use of Premises`/
J 4
5 0
0 3 OwneG (%?a-1 I Address
J o ByS,Cjilni (-v' Address /'.�U ,S. Sf•
�
CONTRACTOR, AGENT
30
Phone
w z
W W
¢a 3i y�_o
c o State License Approved
_ U Y loe PLUMBING INSPECTOR
Water Heater
Dental
Restaurant
WATER
Permit Fee