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CRY OF CUFERIRIO CITY OF CUPERTINO
JUN MR
FOR PLUMBING PERMIT
Date PA , 19
sanitary No.
Permit No
Fee $
o Application 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 apyl ble thereto.
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Use of Premises
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O CONTRACTOR, AGENT
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PLUMBING INSPECTOR
Wash
Washine Machine I 1 II Size I I
Curb
Floor Drain I 1 II WATER SYSTEM
Total 1. l— 1 11 Total Fee 1// • P*)