51167 (3)i3 4� 1 �'
NO. STREET
CITY OF CUPERTINO
w i of APPLICATION FOR PLUMBING PERMIT
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0 e Sanitary No.
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0 a1RltLht� Q ���� 19 _ Permit No .v ii 6 7
W LL Fee
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P Allilati n is hereby made to the City of Cupertino for a permit to install plumbing
01 pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r 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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a Use of Premises
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Owner 6/¢N/� F,141,aN&0
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O CONTRACTOR, AGENT
3 0 Phone '/ Z S --3— S 70
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Address A
WILLIAM D. BEINEVICH
PLUMBING INSPECTOR V
Dish Washer
Washing Machine
Water Softener
Floor Drain I 1 II WATER SYSTEM
Water
Total