51231.1co? I A 0-2 S 1 (,-/ k \ E LQT NO.
No. STREETI _ 4
CRY Of CUPERTINO CITY OF CUPERTINO
z a APPLICATION FOR PLUMBING PERMIT
o JLf 2 1971 Sanitary No.
0
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a Ite 19 Permit No J—/ 1 3 1
3
U Fees G
1 0
Application is hereby made to the City 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
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
c w Cupertino, and all other laws ,f applicable thereto.
Use of Premises IC�SIUe✓lce-
00 11 cc L
r 3 Owner --5r 0, 1 Address �Y: V1 l�� l I Q f Ck
Oz By l r�WIP�� � ) Address �,'VI�V\,- Ui,c .)
CONT ACTOR, AGENT
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- 0 Phone 4s - 4n
w z
w w WILLIAM C. DEP:.^-_=/iCH
o f State License 1 717 l l U
a o Approved
PLUMBING INSPECTOR Ix
Water Heater 11 1 II Size 1 4 1
DRAINAGE
Water Softener
Comb.Sink &Tray I 1 II To Curb I I
Floor Drain
Size
Total