51167S / / I CCc U 'Al pus 40 LOT
NO. STREE.I'
AAP�P�®rP,LICATION FOR PLUMBING PERMIT
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z i 1 - }� CITY OF CUPERTOINO
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x o Sanitary N o.
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0 j Date � 1)(16— Permit Nn �/7
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w LL Pee $
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ah�(}�s eb, made to the City of Cupertino for a permit to install Plumbing
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pi d/�(fixt �8 reverse side hereof, and agrees to install said Brims
I and/or fixtures in accoa � the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicablPC-3,
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LL Use of Premises y W ! tiJ C) L
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3 Owner � ` !QQ r_� c Address 6 6 /(A% / �J �✓�
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J z By co �ri- (_ �L'�C^C S Address �c OGS
O CONTRACTOR, AGENT
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a o �ItState License / / ��� Approved /
V �`� PLUMBING INSPECTOR V
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RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final