51165No. Street Lot No.
�Of sow APPLICATION FOR PLUMBING PERMIT
Agit U 5 dSM-72 `/l/ ti CITY OF CUPERTINO p r
�f �f Sanitary No. !—
196_ Permit No. SWIGS
Fee
Application is hereby made to the City of Cupertino for a permit to install plumbing 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 Cupertino, and all other
laws applicable thereto.
Useof Premises R&5/Pf✓C6
Owner `L N' -
By
By C, 9: 14144 // K
ontractor, Agent
Phone X7`3 ' �7!3 %
State License '.2O fa /
Address n
Address
�-5
Approved7,
Plumbing Inspector </
Water Heater I / I/ o li Size I I
Wash Trav I / I / S,D m STORM DRAINAGE
Comb.Sink & Tray �� To Curb
Dental Unit
Water Svs. Fee
Fermit Fee r}• O"O
Total G» Total Fee � G' h