51187.11
/Y% V' I Sr- 0 le46: J /] I� LOT
NO. STREET
CITY OF CUPERTINO
APPLICATION FOR PLUMBING PERMIT
CRY OF CUPERTwo
Sanitary No,
[).are 197 Permit No.
n Fee $���
.
Appat i. h y 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 in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all n er laws applicable thereto. `
Use of Premises
Owner -4r HE1N Zy
By L.,%F �,r r,c A&(;
CONTRACTOR, AGENT
Phone Z 7[/Ge— 7 7/�
State License Z F G i 8 Z
01
Address
Address y10 loyAa".0
PLUMBING INSPECTOR
[I
Wash
MAIN
To Curb
Floor Drain I 1 II WATER SYSTEM
Total I D 5 011 Total Fee I /Z 0 0