100188of U2e I u-e-c.a-✓ a' -^-- LOT
NO.� STREET
APPLICATION
'� �• '�..i CITY
i/
FOR PLUMBING PERMIT
OF CUPERTINO
Sanitary No.
%U -j J
Date/V-104' -'D ISRE1 196 Permit No
Pee S 7�
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 of Premises
(% C//ONTRAACTOR, AGENT
State
Addressec-t// .Y7
Address/
Approved - I�
�L
PLUMBING INSPECTOR
Water Heatc
I UNITS I FEES II IUNITSI FEES
Sewer
unnals Future Nee
Area Drains Main Drain Pee
r Valves
Fee
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final