51167.3A
c
EE
0
U
E
Y
O
3
r
0
A
� o
.. a
o6 A
U
`o
o
c A
No. Street
CITY OF CUPERTINO
MAR d 1911
Lot No.
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
PDatt`rtf[,� 'b , 196 1
Sanitary No.
Permit No. .S// G 73
Fee $ 19 -CP
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 provisions of the Plumbing Code of the City of Cupertino, and all other
laws applicable thereto.
Use of Premises
Owner TCIGr L • KoyG
By
Contractor, Agent
Phone 2$ l 1611 -
State License
Address Ioq;l U Ltv A(` VISTGC n1,
Address
Plumbing Inspector ✓
FIXTURES
Size
Dish Washer
Machine
Fountain