51182N i
W Z
LOT NO.
NO. SIRE F.I'
P-62-1
APPUCATI J FOR PLUMBING PERMIT Y
. T OF CUPERTINO
B[�-P_ix.l�� vv Sanitary 1�'0. - �a OS
Date IOA Permit No du/ L2
/g
68 Fee $ 29.E n
Application is hereby�fde to, the City, o �Cup'ertino for a permit to install plumbing
pipes and/or fixtures listed �in�fh2 verse side hereof, and agrees to install said prices
and/or fixtures in accordance withal provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicaW-Ithereto.
Use of Premises Va Ak_, 4X1 4 /ct%a-ChLtic. �'zJ
Owner Address ydG��S�7� >&LZ,,6i�?�
By zc - Address I fl Ae
CONTRACTOR, AG T
Phone - , --? %G "T -
State License
Approved WILLIAM D. E=NEVICH
X PLUMBING INSPECTOR
Water
Wash
Machine
Drain
To Curb
Water
15-