51177.1—U�
leis LOT NO.
NO. l 62I
® ARPL ATION FOR PLUMBING PERMIT
�ITY OF CUPERTINO
X Sanitary No.
I t`c�Q 1196761 Permit No
((��4 Fee 5
Apphiod° is hereby made to the City of Cupertino for a permit to install plumbing
n/sin r fixtures listed on the reverse side hereof, and agrees to install said prices
r)fixtures in accordance with the provisions of the Plumbing Cade of the City of
Cupertino, and all other laws applicable theme/�/o.
Use of Premises ._,��j� ,; C/A 16,!4e _
Owner/�{. C/2'�1lG /i1 Address -f' Z'
dam( /G7 E. mss
By % CONTRACTOR,
JACTOR,AGENT �H f Addressz r --Z
Pi---. -'2-,/ --? 3 ,3
Apprl,ed�:.l%fG
PLUMBING INSPECTOR
State Licence lei 5
NUMBER
Dish Washer
Water Softener
# /6
To Curb
Material
t Fee
Fee
DRAINAGE