NO PERMIT NUMBERP
x /9 4611 3�
LOT
NO. STREET �
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
Sanitary No.
Date Permit No
14 X967 Fee $
Application is hereby made to t e City of Cupertino for a permit to install plumbing
and sorafix ure a tr do n the reverse
provi sonsereof, and of the Plumbing Code es to install
o( the C1ty oC
i CR pI�
Cupertino, and all other laws a is ble thereto.
Use of Premises
Address 16W P&&-7.t�.d
Address
WILLIAM D. GatV:ViC:�
Approved
PLUMBING INSPECTOR V
UNITS I FEES
Water
Sprinkler Valves 1 I II Water SYS. Fee
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough, Complete-
.Wain
omplete... Wain Drain
Final...