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LOT NO. I f'J 4�D • �l
NO. STREET
Ah�IC/�F�Q FOR PLUMBING PERMIT
'.� I ) P CUPCRTINO
j� Sanitary No. %oJ-B'
Date ,I 2i,f9 70 O Permit No.
Fee 2�,5�
A Y2l7d/i i reb.0 ERTl1N10y of Cupertino for a permit to install Plumbing
Pipes end 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 other laws applicable thereto.
Use of Premises e_ Jl ��F��/Dl✓ U� �7i
Owner Address
CONTRACTOR, AGENT
Phone 3 *2 `i - 3 -s 9 3
State License 7 `6 O y J
Address h—`"/ 3 5
.if S•J•
?-29-7a �. ✓
Approved
XPLUMBING INSPECTOR
FIXTURES
Size
Dish Washer
Water Softener
STORM
Comb.Sink & Trav I 1 II To Curb I I
Total Fee