511799(T I aL. �✓ 4 ( � LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
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3 � Dat 196!!ZPermit No.
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° 11J`pplication?hereby e the City of Cupertino for a permit to install plumbing
o pipesd/or fixtu{+ isted a reverse side hereof, and agrees to install said prices
iN and/or/iixtures in aY rda �/ h the provisions of the Plumbing Code of the City of
e W Cupertino,�d all othe ws, pplicable thereto.
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Water Hcatc
RECORD OF INSPECTION