Application for Plumbing Permit/O/, O UJ I �Oi7/%.J r�l•C(% LOT NO.
NO. STR ET
APPLICAT10F PLU��rr{{•� PERMIT
V) 4:IT C{ERr�iNO1
2- E y SanQitary 1'b.
0 < Date ^-��A�� , �196Y- r18196`Perm No
UJ D
W a Fee $ �.
n0 ApThca/tion is hereby, made Q1thsYCit1} of �uLe�mo kotra&rmit to install plumbing
0 a 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
U)
Cupertino, and all other laws applicable thereto.
W = L
W Use of Prises=c=d=GG�L' Jr
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3 Owner emC/�/%- "/N',/;vLAddress /i o: c�G% `GtCI'LC'l2.CLw
J o By /r!-Eil�/. sof-! t�IP / Address
MRAPTOR, AGENT
3 W Phone /c.%H •�l��i// �`.-", `�,./�—
/v O
oState License Approved ayT"'
UI PLUMBING INSPECCOR
nes
ns
Valves
UNITS I FEES
'.1
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Plain Drain
Final_