51226LOT NO. / f
NO. /T STREri*313
Al'
/J 1o#BPLICATION FOR PLUMBING PERMIT
n' CITE' OF CUPERTINO
p \, Sanitary Nu.
Dates .� ` 196_ Permit No
Pee $
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'�aws applicable thereto.
Use of
State License
AddrA`So4 Com/�—
Approeed
XPLUMBING INSPECTOR (/
Water Heater
Wash
Units
Material
Comb.Sink & Tray�� To Curb
Dental Unit i
Drinking Fountain
WATER
Water
w