51226NO.
�emm"o ' CITY OF CUPERTINO
"< �ypv ♦ 4 7,f APPLICATION_ FOR PLUMBING PERMIT
r o R1%1 1Y 191'1 Sanitary No.
a 0
a
Iote 197/ Permit No2�65
O &-0
FW 0
�
4 W
oa
ZN
a W
wx
a
J
0 0 0
� N
p a
ZJ
0
�o
3�
-am
w z
w w
rca
O i
a 1�o'7'—
_l
Fee 5_
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 Taws applicable thereto.
Use of Premises //7P S'/��o.ielia ,5-�22�NKLE12 SI/J'%�l►1� C
Owner !.ag LlZRoU Sty -Sl -f( T ` AddressI60-Sl-f(/J1rid• 5 C
By-� PITi,KKLF2. /NC
CONTRACTOR, AGENT
Phone,7-5�7' d /,Dc
----
State License-f-SIR/9-7
Address-7-5— C9IS7-1C9 CIL
c�IMYRELL, GAL.
WILLIAM D. BENEVICH
PLUMBING INSPECTOR
FIXTURES INUMBER I MAIN DRAIN
Units Fees Units
Water Heater I 1 11 Size
Washer
Machine
Fountain
To Curb
Water Svs. Fee
Total Fee