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f1w�h S ET^1 • & Cw14fi1p CITY OF CUPERTINrO
"-i'�� F 6 ,APPLICATION FOR PLUMBING PERMIT
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x o Sanitary iNo.
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o � Ua19 Permit No,
w LL Pee $� S?
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Application is hereby made to the City of Cupertino for a permit to install plumbing
o < pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
>I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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Use of Premises
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o< Owner / F U Address /0eS"�3
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CONTRACTOR, AGENT
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a �O/a % WILLIPS� D. LL-'NEVICH
a o State License o Approved
PLUMBING INSPECTOR
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Dish Washer
Machine
Dental Unit
Water
Permit Fee