51189No. Street /0/66-3 ?192X -w oa P .D2
—SOF
JUN 18 1971 APPLICATION
OF CUPER BIND PERMIT
I
P A. p Sanitary No.
Lot No.
Date Y» r4Y 2 D , 19ea / Permit No.����1'/
Fee$ �r3�
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.
Use of Premises ?00 Q v i P! Yr> t N T GtLO o rr�
rn T
Owner pv�-R-`/ C-0 ..V 7— Address'i-79 Gr9LS-KAO^ V'Fc
By SAN T-o5.E
Contractor, Agent
Phone 275 - 90 4 4—
State License_- 6 43��!_
Address 16 6 S rto G E/ -.s sem.
Approved .
'01plum-bing Inspector
Waste
Comb.S ink & Tray To Curb
Dental Unit
Size
Water
Total