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m ® ( (CATION FOR PLUMBING PERMIT
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Sanitary No.
Lot No.
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ff', ,196_ Permit No. .5/2? -6
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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
Phone --5,7C _ G7 Y, --/
State License_ 71-)- d
Addresirp
J Approved
Plumbing Inspector
riout li
Water Heater I / I/ IT II Size If � I I
Wash
Comb.Sink & Tray �� To Curb
Dental Unit
Restaurant