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NO.
STREFI'
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CITY OF CUPERTINO
" a c/iPPCIArNbON FOR PLUMBING PERMIT
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�LL 7 DEC 14 11
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0 � Uatc 9/ 19 Permit No �/"__
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° Application is hereby made to the City of Cupertino for a permit to install plumbing
`o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fiX(LnCs in accordance with the provisions of the Plumbing Code of the City of
a w - Cupertino, and all All lMAW 'dlaws applicable
iccaaabbl�e thereto. `\
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Use of Premises
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3 Owner X Ne f 4,91ZImAl Address
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� CONTRACTOR, AGENT
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- < Phone) 251- 387-¢
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o State License �'^ Approved
—U�PLUMBING INSPECTOR
Dish Washer
Water Softener I I II Material I I
Comb.Sink &Tray I 1 II To Curb I I
Floor Drain I 1 II WATER SYSTEM
Water