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O P ATION FOR PLUMBING PERMIT
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WrpRahon rs hereby made to the City of Cupertino for a permit to install Plumbing
o 0� .es-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
a w Cupertino, and all other ws applicable thereto.
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W Use of Premises
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O CONTRACTOR, AGEN
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a o State License. Approved
— U Ip iL PLUMBING INSPECTOR
FIXTURES
Comb.Sink &
Dental Unit
Fees
Floor Drain I 1 11 WATER SYSTEM
Water Sys. Fee