51003oc �?S I Cc 0if fZ 7-kez
NO. ST EET
1014
01Y GF Ct7Pg:rwo APPLICATION FOR PLUMBING PERMIT
EP
14 1971
CITY OF CUPERTINO
sanitary N
Val N e --Z- 19/ Permit No
!!! Pee $ 3 SO
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/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. _
OwnerJ-)C -! 0/y �, T,-
By_igcE f 1/ cyw/yt « I
O CONTRACTOR, AGENT
3 am Phone -2- �j
w z
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c o state License
- utl
Address
Address) 7`/ �22� yn 6uT 14V S4-
Approved
`. PLUMBING INSPECTOR
Material
To Main Drain
To Curb
WATER SYST:
Size
Material
TOTALF
Fixture Fee
Main Drain Fee
Storm Drain Ft
Water Sys. Fee
Q.