51167 (2)yl / SS -Z I C: a L c /h b u S 157 y LOT
NO. STaEE.T
APPLICATION FOR
�CIT�l' OF
Date ® Ub 1 ,9 J j�96
PLUMBING PERMIT
CUPERTINO
Sanitary No.
Permit No.
Pec
for a permit to install plumbing
and agrees to install said prices
Plumbing Code of the City of
Application is hereby made to the City, of Cupertino
pipes/(tOyAr Q�@rellp�ip�rjplPq erre side hereof,
and b f xrrureV ac t i provisions of the
Cupertino, and all other laws applicable thereto.
Use of Premises
Owner;6 . rd % �i�...a✓,,-4 }'dress
z By
O CONTRACTOR, AGENT
3 F
—� Phone�S3-5���
w z
w w
rc a
a o State License
— Uf�
WILLIAM D. BENENICH
PLUMBING INSPECTOR
Water Heater
Waste
Size
MAIN
Comb.Sink & Tray�� To Curb
Dental Unit
Drinking Fountain
Water Sys. Fee
Total