51167.1a�G�Z I Cll�JylG1CG1��AGO� LOTNO.
NO. �STRP. F.7�
i� FAPPLICATIONFOR PLUMBING PERMIT
CITYI OF CUPERTINO
ro fAt 221967 _ Sanitary No.
LL l/
oDate r 1962 Permit No / G 7 /
3 a Y OF CUPERTINO Pee $C'�(' S2
j LL
o Application is hereby made to the City of Cupertino for a permit to install plumbing
o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> r 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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� r
a Use of Premises 1iN
0el rid/! Address f
3 Own ` `
� z �� �.., C� /=f Address
O CONTRACTOR, AGE
— Phone
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i LY State License s�� Approved'✓IC.i
ln^i n r_—>
r— 0 PLUMBING INSPECTOR (/
_FIXTURES I NUMBER MAIN DRAIN
UNITS FF.F.S ttwrrc�
Water Closet I3 I II Material I/!/ I I
Shower I / 1 11 To PrOn. Line I ti I
Kitchen $ink
ish Wash / I Not Conn.
Der Sewer Rnx
Comb.Sink&Tray I 1 II To Curb
Floor Drain I 1 11 WATER SYSTEM
Al. FEES
Main Drain Fee
Water Leader
Total