51226F.T
AP.PLIE.ATION FOR PLUMBIN
9 �g� CITY OF CUPERTINO
$:mitary
to /� 196— Fermi
LOT NO, V
31341
G PERMIT
No.
No. 9—/ /Z"
Fee 5.2 8• S-0
(.a plication 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
Addref/ CiC Grc t/�
-' COApTRACT R AGENT
Phone ✓��0 �'/
i vii 7—z►-7�
State License 7>- A pproved
PLUMBING INSPECTOR
FIXTURES
Size
Waste
Comb.Sink & Tray I 1 II To Curb I I
Dental Unit
TER SYSTEM
Water Sys. Fee
Total Fee