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APPJLICATION[tFOR PLUMBING PERMIT
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--CIT OF CUPERTINO
I
(DEC g 1967 Sanitary No.
Date Z2 196 Permit No
f''TY OF CUPFRTINO Fee $�4e Sd
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
• •'
h 111 _
State License 2: / -V�'
Add
Appro,coILLIAM D. BENMCH
PLUMBING INSPECTOR
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I UNITS I FEES II 1UNITSI FEES
Nater Heate
Urinals I Fixture Fee'
rea Drains Main, Drain Fee . 00
Sprinkler Valves I I II Water Sys. Fee I / Sa
RECORD OF INSPECTION
_Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final._