51001.2 (2)I
as ;t- 9 3 I 'd4l-o Y-/' LOT NO.
NO. STREET
' -WPLJCATIONJOOR PLUMBING PERMIT
CITY OF CUPERTINO
(fv1AR 26 1,68 '
Date �� f• '::V , 15t3� Permit No.
Fee $ � :5 —6
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
-' CONTRACTOR, AGENT
Address.�?a r9-3 .e�%ZIZ-.
AddressJ910 C" 6 �cf7, az ,
Approved_( ��� — �,�r _ryas" -"'c- I
PLUMBING INSPECTOR7& ✓
LURES I NUMBER 11 MAIN DRAIN
UNITS FEES
UNITS FEES
Water Heater Size
Water Closets I �� Material
Bath Tubs To Curb
Showers To Prop. Line
Lavatories To Existing
Kitchen Sinks Not Conn.
Dish Washers
Waste Disposals
NVI-6 T...... I 1 11 CTnDAf nD ATMACr
kler Valves
RECORD OF INSPECTION