51226L_Z63f (COLD /� C L7 LOT NO.
NO. STNEE.T I �'
APPLICATION FOR PLUMBING PERMIT
a e CITY OF CUPERTINO
z
s o 9 Sanitary No.
ff o , �iJare - d� /��`'• 196_ Permit Nom Z"
Fees
° 'Applic n is)[Yereby made to the City of Cupertino for a permit to install plumbing
o pipes nc�fixtutes listed on the reverse side hereof, and agrees to install said prices
> a4c Afixturealm accordance with the provisions of the Plumbing Code of the City of
a w Cbp2ifino, and all othq 4awS applicable thereto.
w 2
� r
0 0
Use
° °
7 N
r 3 Own
O a
Z J
z BX2
0
3�
aN Phon
W Z
W W
rc a
a o State
_U
of
/,," 9 L
License 7Y W
i-Z.1-7o
Approved N. -
PLUMBING INSPECTOR {(/
NUMBER
Units Fees
Water
Floor Drain
Size
To
Water Sys. Fee