51179/ � ,w I ' / & LOT NO.
No. sTR P.T
APPLICA IOM FOR PLUMBING PERMIT
z i a CITY OF CUPFRTINO
Sanitary No.
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196— Permit No
Fee $ �a
Vto�the City of Cupertino for a permit to install plumbing
ddon the reverse side hereof, and agrees to install said prices
nce with the provisions of the Plumbing Code of the City of
laws applicable thereto.
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— Phone ✓a,�s 4 Sii
<u tate License
Address / ' �(�'"U•
A�rCS`! -fLa.C.Piirf� •liL..� �QQ/
Approved
PL MBING INSPECTOR
E Water Heate
Sprinkler Valves I I Water Sys. Fee
RECORD OF INSPECTION
Underground Rough...
Partial Rough -
Rough. Complete -
Main Drain
Final...