1397i>z� LOT
NO. STREET
APPLICATION FOR PLUMBING PERMIT
fj�'l OF CUPERTINO
Dat - 1912 Permit No.
Fee $ /
Application is herebyr`,,nade'td-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 of
Address % L' s' `i% '7'e
Address � s;%
Approve
PLUMBING INSPECTOR
IVCs
RECORD OF INSPECTIONAM ,