51211N Q
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1C, 44 qi I �)y,^ aL-,,-, LOT 11.94-D A
NO. STREET (
ItFOR PLUMBING PERMIT
A* OP CUPERTINO
® �p sanitary iA'n. c1
iN%
Date 2 9 •W 7 o Permit No
Fee S 1 y % . 70
AIe{i�(�onASPIC •I� �ilN�ity of Cupertino for a permit to install plumbing
pipes r ures ate 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 10
1;�4 2.6. -t
Owner 06 - «-c._ (Le -.3
By e,4 -11e—
CONTRACTOR, AGENT
Phone 3 ')!q - 3 7 [ 3
State License 2-S S/G `/ 3
Address V4 -5-:5
a�
7-z9-90 'f
AppA,,.L
roved
PLUMBING INSPECTOR - -
Water
NUMBER
Units Fees
Washer
Water Softener
;ink &
Unit
Size
SYSTEM
Total Fee