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EP ADatee 1917/
Lot No.
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
Sanitary No.
Permit No. --<-//S-
0 S�3�
Application is hereby made to the City of Cupertino for a permit to install plumbing pipes
and/or futures listed on the reverse side hereof, and agrees to install said prices and/or fixtures
o d in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other
C 'co laws applicable thereto.
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m m Use of Premises
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o Owner
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Address t3T7 'INT, UlL=IJ
Contractor, Agent / QUA/ tib- C'yr
Phone �� o — 2 l ,T % /
State License 2 1 2 /7-4- 19- Approve�
Plumbing Inspector
Dish
Water Softener I 1 II Material I I
To Curb
Water Svs. Fee
Total
Fees