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fffY OF CUPERilNO
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JUL 21197
APPLICATION FOR PLUMBING PERMIT
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CITY OF CUPERTINO
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Sanitary No.
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Date
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I9;v Permit No.
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Fee 5 3- SD
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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
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in accordance with the provisions
of the Ph robing Code of the City of Cupertino, and all other
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laws applicable thereto.
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Use of Premi
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Owner
Address
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Phone
State License W
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UPlumbing Inspector
MAIN
Dental
Floor Drain I 1 II WATER SYSTEM
Water
Total