51226LOT NO. .r6
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CICATION FOR PLUMBING PERMIT
CITY ON CUPERTINO
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Sanitary No.
Uate 196_ Permit No. J~/, 2-2-4
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Pee$ 28.50
0% Application 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
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws al �licable thereto.
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PLUMBING INSPECTOR
NUMBER
Dish Washer
Water Softener
Floor Drain
STORM
To Curb
Size