51226 (3)r7 7
�,— I LOT NO.
® �/►cPPLi1,1T QN FOR PLUMBING PERMIT
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a (CITY OF CUPERTINO
x A� 12 Iq�1 Sanitary No.
o a [)are /�—y� 70 ,, 196_ Permit No
3U C.!Ty 07
I CU°ERTIR;O Fee $eAte
4
0 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
> r 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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State License
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PLUMBING INSPECTOR
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FIXTURES INUMBER 11 MAIN DRAIN
Units Fees Units
Water Heater / fb Size—
Machine
Total
Material
To Curb
Size
Fee