51177.1C
O
No. Street
Lot No.
��TI TY FOR PLUMBING PERMIT
((((���'((���"' .tf�'j CITY OF PLUM INO
�•�� �t \710 Sanitary No.
Dat '1 S LP 0— Permit No. S/'�/%7. /
Fee $ 7"
ApP[ �dn is hereby made to the City of Cupertino for a permit to install plumbing pipes
and/Mixtures Mixtures 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 applicable thereto. / .> ,
use of Premises /\ syl
Owner �it ff�✓� V ��?'✓ ���
By
Contractor, Agent
Phone �2 SS 3 6 4
State
ApprovedWILL1AM D. BZ-:NZVICI-
Plumbing Inspector
Sink
Total
To Curb
WA
Fee