51167/ k -`^ C2C- / LOT
NO. STRE.E.I'
N < �PATION FOR PLUMBING PERMIT
® TY OF CUPE.RTINO
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isaj'q�f i he City of Cupertino for a permit to install plumbing
'o a p nd/VfixldF P1ERA AII�FNe 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
a w Cupertino, and all other laws applicable thereto.
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Use of Premises
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Address//82 SMA -%U GA
WILLIAM D. DENEVICH
PLUMBING INSPECTOR
FIXTURES NUMBER MAIN DRAIN
Units Fees Units
Water Heater I 1 11 Size
Wash
To Curb
Size
Material
Water S
Fee