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No. Street Lot No.
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vICATION FOR PLUMBING PERMITRT
E .131(9 CITY OF CUPERTINO
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1 V n 3 Sanitary No.
E Dale ( , 190 Permit No.511 b'
3 CITY OF CUPERTINO Fee $IN&*.
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
0 in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other
'c laws applicable thereto.
a o
;e A Use of Premises
A'P T5.
Owner AVE-Z-� GO h15T. <�A . Address
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BY S A'li .J 05V.. NHLFi�tr.�tL 4C / rJ c , Address 16 GS i`i�QS ANE. $ j.
3 Contractor, Agent
gPhone 115-9044 A
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11- /q-7D 7
—f� State License Approved
( Y P tubing Inspector
I Units I Fees I I I Units I Fees
Water
Dish Washer
Comb.Sink & Tray�� To Curb
Dental Unit
Water Sys. Fee
0