51226yC�� LOT NO. Y'S
Nt EF.t' 3Is91 K
ATION FOR PLUMBING PERMIT
�9 O TINO l CITY OF CUPERSanitary \u.
3 )ate 196— Permit No moi, z
wLL Cs Fees 2?•50
10 �G
,f 'pphc'ation is hereby made to the City of Cupertino for a permit to install plumbing
`o a (.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
a w Cupertino, and all other laws applicable thereto.
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Use of Premises
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ao ,u.State License L7 Ykdoo"�pproved
U N., PLUMBING INSPECTOR {�
FIXTURES ]NUMBER II MAIN DRAIN
Wash
Comb.Sink &
Dental Unit
Size
Size
SYSTEM
Water Svs. Fee