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E - APPLICATION FOR PLUMBING PERMIT
04UG'=3 111971 CITY OF CUPERTINO
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® Sanitary No.
f� Y- A'2 1971 Si/77.
E Date Permit No.
Y
3 Fee $13
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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
9 laws applicable thereto.
0
Use of Premises
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° Owner A. Address /0SC"S/-��/'-f%F ^.Ae
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3 Contractor, Agent
° Phone
State License �ollo�c�/O
AddresF-Z ,Aewwmt(JT. dC C
Approved
Plumbing Inspector
FIXTURES I NUMBER II MAIN DRAIN
Wash
Dental
Permit Fee a- 06
Total Total Fee R. S-7