51222.1LOT NO. T
PLUMBING PERMIT
CUPERTINO
Sanitary N
Date 1gpd- Permit No .s /—aa-�L, /
CITY OF CUPERTINO Fee
Application 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
Owner Address Z D,�
By/� Address/ 0 2, Si
CONTRACT , AGENT
.,�. AL 9 - A Lt
State License. ig
Approved_
PLUMBING INSPECTOR
FIXTURES
Water Heater I / I!• 011 Size 4(" 1 1 A/. a D
Comb.Sink & Tray �� To Curb
Dental Unit
Floor
Sink
Ulf
Water Sys. Fee
Total Fee