51167.3No.
APR 2 0 1971
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
Lot No.
Sanitary No. y j
RDat� ' D 196_ Permit No-rG %lld
Fee $�le
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
laws applicable thereto.
w
Use of
Owner
By
Phone d -V / / H 7 /
State License�l�
Approved�5�4
# Plumbing Inspector
FIXTURES I NUMBER II MAIN DRAIN
Dish Washer
Washine Machine I 1 II Size I I
Floor Drain I 1 II WATER SYSTEM
Fee