51146.1NO. STREET'
CITY OF CUPERTINO
LOT
CUMMOPLICATION FOR PLUMBING PERMIT
U1 p Sanitary No.
Permit No ,f-11 r`%✓
4 Fee $ d( —
Application is hereb}'- made to the City ofCupertino 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,,ot applicable thereto.----,,
Use of Premises
CONT ACTOA, AG N/Ty
Phor,' ��/
State Licens
Address72' � G
AddreFss v
ti
Approved /
PLUMBING INSPECTOR
Units
Water Heater
STORM
Comb.Sink & Tray To Curb
Dental Unit