51187/o,��Q
No. Street Lot No.
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a REPLICATION FOR PLUMBING PERMIT
E ?D�
UPERTINO
oSanitary No.
E te / , 196 Permit No..T�/� %
Y (+ TT��// (�[ (� �iFR 1N
s C'Al1p c�ilO iY�t �y'tn�d8"O
Fee S /
v li n e a 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/or fixtures
in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other
c laws applicable thereto.
A ro Use of Premises /�-�j--
o U
Owner 111-Ile%9D7Address/e rl 'V rte/-2 5111216—
By //� I% i-t-�i.— -� nn p �
3 Contractor, Agen iJ �"r'LI
Phone
A n
State License o� �Z-• Approved
j✓ Plumbing Inspector J
Dish Washer
To Curb
WATER
Total Fee