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crrY OF CVPERrINO
G t C APPLICATION FOR OF PLUM IINNG O PERMIT
2 2 1971
I� ^ n Sanitary No.
Date tri 19V Permit NoS'ys? 4
Fee S 6• Q
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
r i /
Owner
By ?,,, GCS
Con racfppo ,'Agent
Phone
State License/ 29��V- l . 1,
Address
Add res.LANOIE PLUMBING CO., Ni
2980 Winchester Boulevard
Campbell, California 9500F
X Approved ^�'� z
Plumbing Inspector
FIXTURES
ME'
Wash Trav I 1 II STORM DRAINAGE
Comb.Sin' & Tray �� To Curb
Dental Unit