2381IlJlc LOT NO.
NO. STREET
2�PCMArTION FOR PLUMBING PERMIT
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r o G9� �Sanitary No.
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nwCVVcBSO irh'e'' bWade tothe City of Cupertino for a permit to �install plumbing
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a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i N and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a m Cupertino, and all othee'r�r laws applicable thereto.
Use of Premises
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a o State License-�o�y3$$ - Approved
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RECORD OF INSPECTION