51016.1\d'� I •�GO/��% LOT NO.
STREET
PLICATION FOR PLUMBING PERMIT
z i a D CITY OF CUPERTINO
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r o Sanitary No.
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o a I a Permit No,'fl"01_
i LL Pee $ a1-
° a /� >n I I�, made to the City of Cupertino for a permit to install plumbing
ocanlY,lrrir ��71'� {�the reverse side hereof, and agrees to install said prices
and/or fixtures m accordaMoith the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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a Use of Premises{ -'D div enF
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O 3 Owner �S%E,PC dva Address %y / /.7iC
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z By,li�J! UretEor ��6. Address�0.�e.r x;aw-
CONTRACT ,AGENT
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Phone -
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a 0 State Licensr��"'� Approved
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PLUMBING INSPECTOR (�
Water Heater
Drain
MAIN
To Curb
Size
Water
t Fee
Fee
LOT NO.
NO. STRE.P.T'
APPLICATION FOR PLUMBING PERMIT
carr of curarnNo CITY OF CUPERTINO
QC I j . Sanitary No..
Date 9'19R�z Permit Nol//
P ,A Pee $ .0. 3 --{�
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 Pecs
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 C E- S -v9- Y'a •""v
Owner Address '5Z6-
By _e
�.
CONTRX&OIC, AGENT
Phone -�- -33
State License,946 a f/ -0
ppe
Address�Q- Ca S�v
Sif'LJ�Ia G�/A+e.�
Approve
D< PLUMBINGINSPECTOR
FEES
Sewer Boxes
NU renals I 1 II Fixture Fee 1 19's -
vaNCs
RECORD
Fee