51226 (2)ILOT NO. � G
c a / s I Is.
L ATION FOR PLUMBING PERMIT
1RMIT
A\OCITY OF CUPERTINO
x p® Sanitary No. '' ,, //
¢ w
o J . to � l% 196_ Permit No. l �b `S
3a
U �y eai i Fee $ z 8.50
W w
'O ro: t tI b, d h C, rC f
,
0 0
a
zN
a w
w Z
� r
a
J
p O
7 N
03
0
ZJ
J
J p
3�
a
_ W
w Z
w w
rc a
02
P ton s sere ) ma e to t e dy o upert no or a permit to install Plumb
w
ng
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 JL4)vs applicable thereto.
Use of
�•-7Nr n�oR, AGENTl T - Addre9Y�lJO
Phone .� / % Y/ /�
�+ 7-? 1- !
� �Y
State License � p � Approvedd_ AAO Lj(JgM/
V PLUMBING INSPECTOR
V
Size
Size
Comb.Sink &
Dental Unit
Floor Drain I 1 II WATER SYSTEM
Water
Total Fee