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No. Street ^ Lot No. 4Zr_
CRY OF CU►EKTINO
JUL 21 1971 APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
P' D / Sanitary No. `---
Date (� , IIPL Permit No.^^,,
Fee Sa.7,5-0
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 o(Premise
Owner
By
Conti
Phone
State License
Address
Approved
Plumbing Inspector ✓`
Dish Washer
Machine
Floor Drain I 1 II WATER SYSTEM
Water Sys, Fee
Permit Fe
Total Fee