51167.3No. �Sttreetm 1 `n Lot No.(
a1 rr / APPLICATION FOR
CUPUR BIND ING PERMIT
IGEC 16 1968 -.
qc
Sanitary No. lr D
A ('", ' r:l 'J^CiY 5i/to73
� Date- - �" �� , 196 Permit No..
3 Fee S-23,50
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
.iii laws applicable thereto
0
U
Use of Premises_
' ° Owner"/2 A/ A Address
v
=h PyJr�,vi7l. �/ 661 i � Address
3
Contractor, Agent
d ° Phone
m A - WILLIAM D_ DENEVICH
State License /A;;'rz9 Approved
��--X Plumbing Inspector
Water Heater
Wash
Comb.Sink &
Dental Unit
Restaurant
Total