100189LOT
NO. sn FP.I'
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
J- �\ l� "� Sanitary \'o,
]% Permit No /V d /,r-%
DEL; — 0 1j5Pee S 7"c—
Application
"—Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes and/or, fizturC 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
Owner
Address 9-aIV46G__ o p ��
Address � jld,44 -G"
State License �x7,5'_241 e Approved
�J- PLUMBING INSPECTOR
Heate
ns
nklcr Vo
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
.Main Drain