51167.3' No. ) Street \� Lot No.
rfDEC APP ICATION FOR PLUMBING PERMIT
E Z 6 iy�8 CITY OF CUPERTINO
N Sanitary No.
0 93
YDate Permit No.
° Fee S�:•�U
3
r 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
0 in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other
"P laws applicable thereto.
0
Use of Premises// A
/i,t00 Aiw
o U aa -i9 .ri
19
° Owner i Address
c m01
By Address
Contractor, Agent
3 Phone
— -c� State License rz9V Approved WILLng D. G:CNEVICF
/�. Plumbing Inspector
Fees
Water Heater I / 1 II Size 1I/- I
Wash Tray I 1 II STORM DRAINAGE
Water Softener
Sink
To Curb
Fee