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APPLICATIIO&FOkRr PLUMBING PERMIT
ISanitary iA'o.
Date DEC 1 21q 8 Permit No s.S—.�' `/—d
Pee $ % '0�
Application is KeYel{y>{ma I�Fto CUPt��T 40tino for a permit to install plumbing,
pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws aplaica Ic thereto.
Use of Premises
T - /
Owner
By Address
�n CONTRACTOR, AGENT
Phonemic
State License
Approved VALLIAiil D. ZZ.-:IWIC.�1
/ PLUMBING INSPECTOR
UNITS
Heate
V a lvcs
Fee
RECORD OF INSPECTION
Underground Rough
-Partial Rough
Rough. Complete
x1ain Drain
Final .