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No. Street Lot No.
f0 L- E uN1T1
CATION FOR PLUMBING PERMIT ?--a u- -ri
i 91 U CITY OF CUPERTINO Z - F �,,Tr
®/JAN
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Sanitary No. ! 10I �^
CIT l7,( e�Di'W ' 197a- Permit No. 5II.7
Fee 5 14155!
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 PCPYS
Owner Address
By5 W J1 S% HELtk ttJ1GAi lwlr_.
Contractor, Agent
PhoneGIO44
State License 18S
Address liof<,� "t25 AVE 0S,J.
Al5proved %
'-L—� Plumbing Inspector V
F IXTJfi C --,T 6K ��•
imp]
Dish Washer
Water
MAIN
Comb.Sink & Tray To Curb
Dental Unit
Total
Iq3