51167 (2)LOT NO. I�
N STR F. F.I'
P 1Q&TION FOR PLUMBING PERMIT
< �+ CITY OF CUPERTINO
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r g MAY - 66 Sanitary No. _
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10
o `� UVare 19(/� Permit No %
3 j IT C� ��(� Pee $ ,Z6
o Application Is f4IAU 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
> . 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.
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Use of Premises
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o a Owner �g.�i �a Address= S [i q
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i - CON AACTOA, AGENT A
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a o`pytate License /XG -s 4 Approved / /
- U 1`r / PLUMBING INSPECTOR `'
I UNITS I FEES II IUNITSI FEES I
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Fee
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RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Alam Uram I
Final