2007NO. STREET
AgP,LIQ :1 FOR PLUMBING
d ® ` C SOF CUPERTINO
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x o Sanitary
LOT No.
PERMIT
No.
M a gate j APR 5 1963 q6_ Permit No aoo 7
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O ApejcFt 6n k� fher�l{,1tp%RttTjthe(City�of Cupertino for a permit to install plumbing
`o < pipes an /or fixtures listed on the reverse side hereof, and agrees to install said prices
i < and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Q w Cupertino, and all other laws applicable th)PreA.
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3 Ow Address
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z 13 - Address
3 CONTRACTOR; AN7'�x_
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e Liceie Approve
tit
>'yl `PLUMBING INSPECTOR
t
Water Heater
Waste
Is
ri6kI,r Valves
o Main vrain
o Curb
I
'ATER SYSTEM+
ize
laterial*
•'-TOTAL FEES
isture Fee
4ain.Drain Fee •-a
Corm Drain Fee
�/aterySys. Fee _p
'crmiL.Fee
RECORD OF INSPECTIQN o
Undereround Rough...--Y�'+-•ti '.
,.Rough, Complete -
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omplete..V•Iain' Drain -' " r•1� Z
Final...
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