51084/r -? 0 LOT NO.
Q TR E
® I FOR PLUMBING PERMIT
a I OE CUPERTINO
YW "25
pSanitary No.
0 a Date0?61 Permit No 3iv1J
i LL Eee $ p
O Application is hereby made to the City of Cupertino for a permit to install plumbing
o < pipes and/or fixtures listed on the 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
< w Cupertino, and all other laws applicable thereto.
LL Use of Premises �{S
00
o
a Owner �� - Address-/ I?O (l�U /l K
zJ r /
Jz z O
By ENT
/ '-/ Address
CONTRACTOR, A
3�
ao State License L ��•/t%�'/ Approved '
— U \� PLUMBING INSPECTOR
I UNITS I FEES 11 IUNITSI FEES
Boxes
Area Urams I 1 II Main Drain Fee I
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough-. Complete..
\Qain Drain
Final...