51189 -POOL #4o'�
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' d JUN 18 1971 CITY OF CUPERTINO
ZAPPLICATION FOR PLUMBING PERMIT
z
y p Ph I bomit ry No.
p J Date ` I� Permit No
3u
Pee $
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 5191 ttnr` I x� C�� L CT�a�� PvT
Owner
By��
C NTRACTOR, AGENT
Phonet��
State License
Addresstlsl- C -e% t'�4 01EU 7
Address Q\O SaAN l�l� ��1t
WILLIAM D. SENEVICH
—�' PLUMBING INSPECTOR '�
Units
Water Heater I I 1 II Size I I
Waste
Wash Tray I 1 II STORM DRAINAGE
Comb.Sink & Tray To Curb
Dental Unit
Material
Water Sys. Fee
5'D