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gtp 21 TY CITY OF CUPERTINO
" a &LICATION FOR 'PLUMBING PERMIT
x X P A p Sanitary 5a 17 l3
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0 < Date5-0 Z 19W Permit No.
3
O Fee $ z • c
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Application is hereby made to the Cit}' of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
Use of Premises 5TIre✓/,f3 �7
00 .
oa Owner_.�/?�l /-f"i7 Address
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J z By(la.✓/,0 (� S f /.rrd/�Zi fir. Address
,CONTRACTOR, AGENT
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—0 Phone _�l�`"•
0 {o] State License -1 5150 C/5 Approved /
-/ - PLUMBING INSPECTOR
FIXTURES I NUMBER II MAIN DRAIN
Sue
Water Softener I I If Material I I
To Curb
WA'
Size
Water Sys. Fee
Fee