51226 (2)NO. EF.I'
SIA 1 N FOR PLUMBING PERMIT
z a � I�[�{TY OF CUPERTINO
W Z � 11��Ms�l3f/ul
a o ( -� (c7� Sanitary No.
R W ��'A- -�� 5/226
o � Uatc 196— Permit No
3u
^^'' ��// ��C[ ((�1 pp DD'��(� nn,,((�� Pee $ 2 8, 5 o
Ct l lcalidn is41uFb�h1aV�'1i5.1he 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 othe'laws applicable thereto.
Use of Premises
1
Owner
1
II
�7CONTRAC QR, AGENT
Phone 3 / af- \ ' 1
State License/ 7% k&
Approved40-4�
PLUMBING INSPECTOR
Water
Closet
Washer
Drain
MAIN
To Curb
Permit Fe
Total Fee
9-1576
DRAINAGE