51001.3Y
��3J /1 Li rJ�.L 62 T LOT NO, 913
NO. STREF.i'
APPLICATION FOR PLUMBING
e'1=TY OF CUPERTINO
PERMIT
V
I-� � p'�t Sanitary No.
Date AII(—MV 19 Permit No MoD 1-3
Pee $ -3 /, 0 a
Apphcationtis hereby made to the City of Cupertino for a permit to install plumbing
pipes and/or fixture IisrcdjonpfTe reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with ttHelprovisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of
Premises
Owner��11 _1kz_ '-fi . Address',,"
By/.�KrS7ci��/" ✓f�Gb" .
CONTRACTOR, AGENT v'
Phoneme C1- T' -,E0 7 7
State License .3,4
Address 7 i�/.L��� i✓ ��osC
ApprovedWILL1ANI 11.
--4
PLUMBING INSPECTOR f'-�
FEES
Water Heate
Its
nklcr Vo
fl7
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Slain Drain
Final .