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03/J t a,-4- LOT NO.
NO.
WPPL1011ION FOR PLUMBING PERMIT
CITY OF CUPERTINO
`1 � !ao S.mitary No.
I to 7 `- 196_ Permit No
G
(� Fee 5 3 % 3=
Ap1, tid[il�s hereby made to the City of Cupertino for a permit to install plumbing
pipe Ln��'or Gxhlres listed on the reverse side hereof, and agrees to install said prices
andiir fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises 1 2 64w1 ay -
Owner OAg, Co Address
Z By NQz to .
O CO NTRACTOR, AGENT
3�
- .`n Phone 'Z 19 8 / � 0
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State
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Address 2 4/ SS v¢y� C7no
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Approved /
y PLUMBING INSPECTOR 1(
Units
Comb.Sink &
Dental Unit
Sink
Size
w.
Total
SYSTEM