51192 (2)Id Z 0 LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
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CUPERTINO
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LL I Cee S 0
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LL O ApplrtrtrlpV ise of Cupertino for a permit to install plumbing
O a pipes andy6r fixtures hs e on t e reverse side hereof, and agrees to Install said prices
> r and/or fixtures in accordance with the provisions of the Plumbing Code of the City Of
a w Cupertino, and all other law applicable thereto.
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Use of Premises _
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oaOwnertz'/:% d— Address
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CONT ACTOR, AGENT
— Phone��r`ji310 WILLIAM i, jjit;:VICH
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a o State License ,� 9 S— S-0 S Approved
U� PLUMBING INSPECTOR
Water Heate
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Sewer
RECORD OF INSPECTION
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