51231.1NO.
CRY Of CLIVERTNO
—UV
1.7 1971
LOT NO. 3 e/
M F. F.I10 l, '
CITY OF CUPERTINO
APPLICATION FOR PLUMBING PERMIT
A, I C' , 19 7
Sanitary No.
Permit No , /
Pee 5 Z 3.4'0
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 e --)J C) N c. e
Owner C-) ^ V Address' (^a'AlhC / )CICIfC,
By � (i to )�e�l l Address 1/t' `rJV� - I C�:J
CONI' ACTOR, AGENT
Phone —�L2 4-cl
State License 1 (o CoglApproved W'LLIAM D. SENEViCHH
4' PLUMBING INSPECTOR
Size
Dish
Water Softener I 1 II Material I I
To Curb
Dental Unit
Size
Water Svs. Fee
Total
UJ