51179 (2)/9
No. Street
APPLICATION FOR PLUMBING PERMIT
qfy Of OIFW040 CITY OF CUPERTINO
Lot No. S -1
APR 1� 1971 Sanitary No.
Date , 196 Permit No.
P A Fee $ /i =
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 auolicable thereto.
Use of Premises
N
Owner Hou( K\lit_IN.
By 4,y N D GT FOots
Contractor, Agent
Phone �' - If % y
State License C 5- j -/Oc 9�1' J
Address
Addressl- jS er �nilllC�r�'
Approved
lumbing I nspector
Dish Washer
Waste Disco
Size
Water Softener
MAIN
Comb.Sink & Tray To Curb
Dental Unit
Water
Total