51226 (2)Y�G3 7 I A"I46� LOT NO.
NO. § REEI10''
iPka^^^Appp'''���� N FOR PLUMBING PERMIT
py � TY OF CUPERTINO
�J 1 tl�i '�
Sanitary No.
Da -1,P"r ,Pr 0 196_ Permit No 5122 6
/� �({'��T Pee $
O� ^' 1� MSU �'''�
- In11>plrcah mss hri�b}�r e to ie City of Cupertino fora 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
Of
Ow Address��, l4
Address
CONTRACTOR, AG NT
Phone
�, to License
L
I/
Approved:�..
PLUMBING INSPECTOR
Fvr,*E cbvNT oz 9• tf 2)
Water Heater
Material
Wash
Comb.Sink & Tray To Curb
Dental Unit
Drinkinz Fountain
WA
Water Sys. Fee
Total
Fees