4999— wwc`1C� LOT NO.
NO. STHE.Et'
IG TION FOR PLUMBING PERMIT
z `
w z OP CUPERTINO
x o Sanitary No.
Q, 2
o < Date1LIN
U 'i 198
6— Permit No
3
i w Pee S
° A iorj�['he(�j� ��q'yq�j�Cit}' of Cupertino for a permit to install plumbing
0 a Pipe r}<i Or in
ture`a'W eFlNil16U(bhverse side hereof, and agrees to install said prices
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws a plicable thereto.
w x
� r
a Use of Prcmise
00
3 Owner! '/Leff 1211fdy 4-t Aef D
oa —�
Z J
BY
° CONT AC R, AGENT
— � Phone �
wz
w w •
¢ a
a o State License
—U
Wr
Approved"i �"
PLUMBING INSPECTOR
ns
Boxes
n Fee
sprinkler Valves I I II Water Sys. Fee
oti
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough Complete
Main Drain
Final