51226 (2)A" Li � LOT NO. �y
" STR -11576 R
_ APPLICATION FOR PLUMBING PERMIT
z a �9 CITY OF CUPERTINO
0 �9
x 0 Sanitrtry \0.
0 4 \NO
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0 a U3te �p 196— Permit No
30 G r
w4 \:•`9. Pee$ 20 •J�
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catloh i hereby made to the City of Cupertino for a permit to install plumbing
'o w pi and/ot tures listed on the reverse side hereof, and agrees to install said prices
r 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.
wz I
.. Use of Premises
00
0 3 Own _
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CO TRACT AGENT
3 a��— 0 Phnne L Y
cv.State License
11
A1pproved
.-k PLUMBING INSPECTOR
Comb.Sink &
Dental Unit
WATER
Fees