51226LOT NO. -1r
NO.
TION FOR PLUMBING PERMIT
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i i - CITY OF CUPERTINO
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° Applica�i� is hereby made to the City of Cupertino for a permit to install plumbing
o w pipes,ttld/or fixtures listed on the reverse side hereof, and agrees to install said prices
i I anor, fixtures in accordance with the provisions of the Plumbing Code of the City of
a W Cupertino, and all other laws applicable thereto.
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W Use of Premises
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Xrd, PLUMBING INSPECTOR
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Water Heater
Wash Tray I 1 11 STORM DRAINAGE
Material
Comb.Sink & Tray To Curb
Dental Unit
Water Sys. Fee
Total Fee