51192.2 (2)No. Street
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Lot No.
EE �A KATION FOR PLUMBING PERMIT
.:;q Jill D CITY OF CUPERTINO
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I N n 7o Sanitary No.
�G [j� U
E Date / Y.. , 196 _ Permit No.
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3 CIT QF WARD Fee S�
tca is e 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
o in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other
A-E laws applicable thereto. `
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,c m Use of Premises
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' ° Owner[,
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Phone 73/"' ��'!�d /� '7•
State License--2��9`y� _ Approve
Plumbing Inspector
FIXTURES
Water Heater
Wash
Comb.Sink &
Dental Unit
Permit Fe
Total Fee