51104I" APPLICATIPIY FOR PLUMBING PERMIT
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W f Nov 1965 OF CUPF.RTINO
x o Sanitary No.
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3U DaGe`t —1�96A Permit No 0r
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Application is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
i N and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
n Use of Premises
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PLUMBING INSPECEOR /
UNITS I FEES
Sprinklcr Vnivcs I 1 11 Water Sys. Fee
RECORD OF INSPECTION /
Underground Rough...
Partial Rough_.
.Rough. Complete..
\4ain Drain
Final...