51253/976 Yyi (77�ZZIS . ed
No. Street
CV OF cxzo"D APPLICACIOON FOR OF PLUM IINO NG PERMIT
pPR 22 1971 Sanitary No.
Lot No.
Date 'S".— Y�' , 19(7 Permit No. / .S
00
Fee S
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
Owner
Address
By f Address/.2 7 Z� Gi"
Contractor, Agent�jyr nD�yLe
Phone X71 7C/S
State License t Ia Approved
Plumbing Inspector
Water Heater I 1 II Size 41 ' I I
Wash Trav I / 1 II STORM DRAINAGE
Comb.Sink & Trav I I II To Curb I I
Dental Unit
Floor Drain 11 WA'
Hooper Size