51211,c 355 &".&-
LOT NO.
—APPL TION FOR PLUMBING PERMIT
N Q
z _ p� CITY OF CUPF.RTINO
Sanitary No.
4 ��9�21- ����
° Q' a4F 196
O — Permit No 512 I -
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a
� ica2ibn is hereb}' made to the City of Cupertino Cor a permit to install plumbing
oa pend/or fixtures listed on the reverse side hereof, and agrees to install said prices
I 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.
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J 4
Use of Premises f�+✓1A/ '
iN Y -K 0 1.2 C&
r 3 Owner Address
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J z By %Ll.n..o� l-..�^'•.''�'""y Address
CONTRACTOR, AGENT
-Phone
7-22-7b
a ' State License ��3 Approved /
UIF1.V X PLUMBING INSPECTOR '/
Water Heater
Wash
MAIN
Material
_ Comb.Sink & Tray To Curb
Dental Unit
Size
Total