51226Y/� Kms"` Ley LOT NO. V/
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N �t6PL !TION FOR PLUMBING PERMIT
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Z t' OF C[IPIiRTINO
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Sanitary No.
R LL \ 4 I 4 L{O
o < ate Cj (96_ Permit No
3 U
0
(
t1Pee $
CApphcation 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
tState Liccnse / . / -
Id -
15
Addresb'/
—7�
7 -2i -v
PLUMBING INSPECTOR
FIXTURES
I Units I Fees II 1 Clnitc I Fees
Size
Dish Washer
Water Softener
STORM
Comb.Sink & Tray To Curb
Dental Unit