100097LOT
NO, STREE.I'
APPLICATION FOR PLUMBING PERMIT
a CITY OF CUPGRTINO
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r o Sanitary No.
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o Date 6_ Permit No i
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196 Fee $ C05 t!ll
o App'IiEati i�i(is hereby made totreverse
ty of Cupertino for a permit to install Plumbing
o pipes and/or G-xt}{sted on side hereof, and agrees to install saidrices
> and/or fixtures it, 'nfRf with the provisions of the Plumbing Code of the City of
a w Cupertino, and all uthe )licable thereto.
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Use of Pre 'ses
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r 3 Owner 47W'ddress S S
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O CONTRACTOR, AGENT 6 /
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a o State License— 7y�i .Approved_
U PLUMBING INSPECTOR
`X/atcr
xture
Fee
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
\•Iain Drain
Final .
FEES