5106802 0 os/ & A LOT
NO. STREET
APPLICATION FOR PLUMBING PERMIT
w CITY OF CUPERTINO
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o Sanitary No. p
0 � Date 'GV' ..• --'y t7� Permit No /J 6O
3 u` t;
Pee $ 4 Q
Appli �o e e � to d}' of Cupertino for a permit to install plumbing
01 pipes and/or fixtures listed on the reverse side hereof, and agrees to install said Prices
> and o es�jt ac provisions of the PlumbingCode of the City of
a w Cuper ndWu ot1,y¢)iii�littibC thereto. }
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Use of Premises -t;I E'r%j/r of frc r'
00
0 3 Owner.
• Address �e J/ -}
a BV /%+fj�%♦ Com, �y �."�`+'�Address )30 C4"'Iyul Vi SU.
n CONl'RACTOR,AGENT
3`X93- �3yo
- `m Phone
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of State License �9��/� Approved- �(
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UPLUMBING INSPECTOR
FEES
Heate
ns
ze
V a Ives
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final