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No B.F. pej.
S AEF.I'
APP-LI
N <CON FOR PLUMBING PERMIT
= i ® G78��` C OP CUPIiRTINO / g�
wrc b
x O Sanitary No.
3 a Dare,!zQ Permit No
w LL Pee $
�2-9, a'a
so
A pn i reWT t , of Cu ertino for a permit to install plumbing
`o piped �ot fiiFLi�resXtl fi�th�tlerse side hereof, and agrees to install sid price
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
LL Use of Premises
00
> N
r 3 Owner Address moi!✓ OZ e
o a
ZJ _
a By Address ,A1//Yi
3 F p CONTRA TOR, AGENT
Phone y \' n
2 State License /4 G6 �_/�_N
®
oApproved
A/PLUMBING INSPECTOR
NUMBER
Softener
Size
STORM
To Curb
Size
Water
I — Permit Fee
Total / < I Tntal Fee