51226LOT NO.
�y
NO P �FATION FOR PLUMBING PERMIT
R
" a CITY OF CUPERTINO
w ``A\�n`� � Sanitary No.
3 I�atN �Q \ , 196_ Permit No .��, Z Z6
Pee $
10
plication is hereby made to the City of Cupertino for a permit to install Plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> h6d%or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
w ��a w Use of Premises t
00 L{/
3 Own .- -LCI Addre
oa r
z/f�:�C /✓ �! ,t� Addr�7'J
O _ CONTRACTOR, AGENT
— m Phone no
a o Stale License pp
U l"L
PLUMBING INSPECTOR V/
Water Heater
Washer
Comb.Sink & Tray�� To Curb
Dental Unit
WA
Water Svs. Fee
Total