51167.3p No: Street r Lot No. 2/0
aAPPLICATION FOR PLUMBING PERMIT
E fDEC 1 G 1958. CITY OF CUPERTINO
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v Sanitary No.
E Date r• -r r T 1 J ��, I96� Permit No. Si/, % .3
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° Fee S23 j t)
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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
o in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other
'e laws applicable thereto. ^
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Use of Premises
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v� By jj=�j}Qm/i�Z2
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3 Contractor, Agent
° Phone
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n State License /,,, lLs- / Approved WILLIAM D. EZN2VIC1
X (/ Plumbing Inspector
Wash
Size
Comb.Sink &
Dental Unit
Restaurant
Fee