51117/
No. Street Lot No.
Date
APPLIC IO G PERMIT
VOCT
IT bJi ONo.
S 3 pp
196_ 1J0� Permit No. `f� 1
Application is hereby madAlttlle CO
and/or fixtures listed on the reverse side hi
in accordance with the pr visions of the PI
laws applicable thereto. 7w
Use
Owner
O
Fee $ (a =
ff rmit to install plumbing pipes
toYnstall said prices and/or fixtures
the City of Cupertino, and all ol6er
Address
Phone 2- r J— b2 3
State License ^z• — Approve -
umbmg Inspector
Water Heater I 1 II Size I I
Dish
Wash Tray I I II STORM DRAINAGE
Comb.Sink & Tray To Curb
Dental Unit
Material