51182MENEVZ0=0 V'/
9 No. Street
C CRY OF CUFE:TINO
W
E MAR 31 1971
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V
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Lot No.
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
= Sanitary No.
Date, v , 198Permit No✓//�
Fee $
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.
— A — _
Use of Premises
Owner we-j—F -C � d
By �,cl tJS f:T PaOLS
Contractor, Agent
Phone `Z cl V KS S (
State License
Address Ggg S, L4(Nc If%7ko-
Plumbing Inspector v
Water Heater
Wash
Comb.Sink & Tray�� To Curb
Dental Unit
Drain
Total