51175.No. Street
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Lot No.
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
!AY 71971
Date '- —
Sanitary No.
Permit NoA—// ?i
P Fee S 3.50
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
in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other
laws applicable thereto.
Use of Premises J%H % L e K_
Owner�i LL// P LS Address /[ ..�1a ky"y/ 4'V
By IVZeg �.y fS 109 �L,I,I ��. jy p Address (t(/}s
Contractor, Agent
Phone 7— 3-2- — -7-3.3 6
State License /.1-- 3 -? se 7
5-7-71 ✓u�l �
Approved
Plumbing Inspector.
MAIN
Water
Comb.Sink & Tray To Curb _
Dental Unit
SYSTEM