51177.1 (2)LOT
NO. STREF.I'
APPLICATION FOR PLUMBING PERMIT
Y OF CUPERTINO
® Sanitary No.
Date 6_ Permit No S // %
Uk3 14 litu Pee S �z d_
� ` Y n is her ftp v,ity of Cupertino Cora Permit to install said
plumbing
pipes 1 r�t(x t�re It �erse side hereof, and agrees to install said prices
and ix ores m actor ante wrt the Provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
n •
Use of Premises
B},
CONTACTOR,AGENT
Phone X ��•� — 7,r
State
WILLIAM D. P._NEVICH
PLUMBING INSPECTOR
Size
Comb.Sink &_Tray�� To Curb
Dental Unit —
Floor
Sink
Water Sys. Fee
Total Fee