51167.2C
o �
T
� o
n n
o �?
� o
o ^
c n
3 s
No.
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
j.
Lot No.�_
Sanitary No. (/07 A
Date oZ <3-- 19�. Perrnt,No.
(1
k, - - u mil
/^r^ roto Fee S;�N
Application is hereby made to the City of Cupertino,for a,permit to -install plumbing pipes
-and/or -fixtures -listed -omthe -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. n ._Xr
Use of Premises
Dwelling
i ng
OwnerDitz Crane Company
By Palm Plumbing Company
�r Contractor, Agent
o�. �..,. 247-2323
State License 186579
.33y�ssDe La Cruz Boulevard
Approved,
X, Plumbing Inspector t4
NUMBER
Dish Washer
Floor Drain
Size
To Curb
Size
Total Fee