51167.3/0 X /,� q14 !// iA2 LOT NO.
NO. STItEEI'
CITY OF CUPERTINO
" dCrrr of curarNp APPLICATION FOR PLUMBING PERMIT
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xN1 sanitary No.
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0UlJate Q 19 _ 19 /l Permit No �r4_SL7d?
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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
> I and/or 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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Use of Premises
00
oa Owne Address /O 9S6
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�� AddressYle7'
O CO TRACTOR, AGENT
Phone
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a o sate License �.�-� Approved WILLIAM D. BENEVICH
— U PLUMBING INSPECTOR /
Water Closet
Dish Washer
To
Dental
Permit Fee e2'��
Total Total Fee