51226-ll- LOT NO.
NO. -BYRE. F.I'
+576
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APPLICATION FOR PLUMBING PERMIT "
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CITY OF CUPERTINO
w 1� sanitary No.
196— Permit No S i 2-2 -6
i LL ((���,Qt-' • Pee 5 2 $ 50
O A p�ttstiorl-.is�hereby made to the City of Cupertino for a permit to install plumbing
o and or Ertfres listed on the reverse side hereof, and agrees to install said prices
a (an'd or fixtzrcs in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
Use of Premises`{G�^`.1
00 _
oa Owner �aG�-z/ Addre7S��//p, zG�-t'`'���»t Ltanr
z J////�/ ,/ • �� AddrLS��'v
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� C CONGpTRACT/qA, AGPNT
3F O_ /O, i��
- 0 Phone
7-2l-76)
as State License 1-74- i�� Approved •✓
U PLUMBING INSPECTOR
X
MAIN
Water Heater
Waste
Material
To Curb
Dental
Water
Total