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No. Street Lot No.
C7i'f OF CLT511"o
F E B 18 1971
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
D
Sanitary No.
Dat V 1196— Permit No.,5 .-/J- 7
Fee$ 32�—
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
in accordance with the provisions of the Plumbing Code of the City of Cupertino, and all other
laws applicable thereto.
Use of Premises
Owner
State License if - /'!� 5 / Z
Plumbing Inspector
Dish Washer
Water Softener I I If Material I I
Colnb.Sink & Tray I I II To Curb
Dental "nil
Material
I 1 11 Permit Fee
Total
(Z t.1
Fee .—..