51167No. STREEI'
TION
TY
LOT NO.—
FOR PLUMBING PERMIT
OF CUPERTINO
p Sanitary No.
1)ate �9 196t, Permit No –f -11(o
/�
Fee $ Oq
C'NpTYilicG n iQjpgRWjjgb'the City, of Cupertino for a permit to install plumbing
pipes and/or fixtures �4jj H'h1i e 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
Cupertino, and all other laws applicable thereto.
Use of Premises
�
Ownei-4� '
BI CON' ACTOR, AGENT•
Phone
State License � 1/— ? 9
INSPECTOR
Hcatc
RAM
Sprinkler Valves I 1 11 Water Sys. Fee I ). r -C
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final .