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LOT NO. A
NO. STBEF.I'
APPLICATION FOR PLUMBING PERMIT
Off of GHATiNO CITY OF CUPERTINO
OCT 14 19�
Bate—/D - , Icy/ -
Sanitary No.
A Permit No, -5-1d Do.
P
C'!
0- I ® Pee $ Z G! • .S Q
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 otherlawsapplicable thereto.,, J
Use of .Premises
Ownere�-r2�z 41, rte. Address
13Y1�CON1.< G
TRAC ,AGENT
Phone c,t i<G- Z -F 9 j
State
�r
Address/ -?"a <54, ,S=7 So -
Approved
PLUMBING INSPECTOR
Water Heater
Water Closet
Dental
To Curb
Size
Water Sys. Fee
Permit Fee a
Totem /? /9 Total Fee Ii S