51211/04 / 5 I z'l. 0.%t, _ , LOT NO.
NO .F.i'
TION FOR PLUMBING PERMIT
P'01AP
Y OP CUPERTINO
�M`�� \.`O Sanitary No.
196_ Permit No
G�v Pee $
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� APlie(% n a hereby made to the City of Cupertino for a Permit to install plumbing
`o < p� kid/or fixtures listed on the reverse side hereof, and agrees to install said prices
> I a r fixtures in accordance with the provisions of the Plumbing Code of the City of
< w Cupertino, and all other laws applicable thereto.
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Use of Premises -7 c4ij•
Owner.0CO Address
O CONTRACTOR, AGENT
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-0 Phone
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a o State
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License ?- 7 S 6 53
AddressV/35-A)at-Y-9At•C•
4�1,
7-22-70
Approved
PLUMBING INSPECTOR
V
Water Heater
To Curb
Dental
WA'
Size
Water
Total
.11