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A CATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
C)� Sanitary No.
! U. P �- 196— Permit No, C7, LZ—C
Fee 9 2:r-50
Appli(?At bn is hereby made to the City of Cupertino for a permit to install plumbing
Pipe .1�nd%or fixtures listed on the reverse side hereof, and agrees to install said prices
a�cA be fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other 1, ws applicable thereto.
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Use of .
tate License 10'22,1-F1
Addr
Addrl�s��!(/
Approved
PLUMBING INSPECTOR V
MAIN
Water Heater
Wash
Comb.Sink & Tray To Curb
Dental Unit
Drinking Fountain
TER
Water Sys. Fee
Total