51189 - POOL #1\ cL-)
w�U(� 18 1971
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CITY OF CUPERTINO
APPLICATION FOR PLUMBING PERMIT
�e Sanitary No.
¢ 17ateI� —' 19�\ Permit No ..�//P.�
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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 in accordance with the provisions of the -Plumbing Code of the City of
Cupertino, and all other laws ,npplicable thereto.
Use of PremisesiirU
Owner-'Aot%\I Qt -AST w\IM AddressLM i�}` Itn Mt0leq-)
ll11.1, AddressC110 v--Mo-t n
CONTRACTOR, AG NT
Phone t3
Sy1tate License�Z'L'�
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Approved"LL1AM D. SENEV[t-
PLUMBING INSPECTOR Ci
FIXTURES 1 NUMBER II MAIN DRAIN
Dish Washer
Washing Machine'
(� Size
Water Softener T Material
To Curb
Size
Water
Total