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• LOT NO. 5
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19'QPPLICATION FOR PLUMBING PERM
CITY OF CUPERTINO
P A. ' D// /� Sanitary No.
Date (y 19R/ Permit No �' 3
S�
Fee $_ a2�
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 p visions of the Plumbing Code of the City of
Cupertino, and all other lay 5�tpplicabythereto.
Use of
Phone oL�-5'' _/�"/_Q 6 1-- ,
1
State License Approved
/ ' /
//�q /\ PLOMDING INSPECTdI�
FIXTURES
Dish Washer
Water Softener
Floor
Size
To Curb
Material
DRAINAGE