511674 ,l, // I L (�' V��. LOT NO,
NO. STREF.I'
APPLICATION FOR PLUMBING PERMIT
z jais'+iy P CUPERTINO
Ir
ro Sanitary iN'o.
o :1 Date � 16 Permit No
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w LL Pee $
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� APplic : I h y i lde to the City, of Cupertino for a permit to install Plumbing
0 1- Pipes an / r 01 Of side hereol, and agrees to install said prices
a < and/or fixtures in accordance svi l rt ovisions of the Plumbing Code of the City of
a Cupertino, and a of a laws appli I eretto.
` Use o rem'
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a o 1 State Licen. 0�7 Jy Approved U �'
—04 04 PLUMBING INSPECTOR ✓
FEES
Water Heate
fixture
rca Urates
klcr Val,cs
U
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final