51167LOT
NO. STREE.I'
APPLICATION FOR PLUMBING PERMIT
W `- CITY OF CUPERTINO
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0 IJat N 19S7 !' 1961 Permit No —1.1 a ,7
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0 Application is hereby made to the City of Cupertino for a permit to install plumbing
w (� tr55�� d���r(I�x Gcs(� y� reverse side hereof, and agrees to install said riccs
I arkll17 xMtes ih' to dhhtclµ�th the provisions of the Plumbing Code of the City of
a w Cupertino, and all laws applicabletI)ereto.
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Use of Premises
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CQNTRACTO AClENT
3a X293 -oil 9
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a �L/o State Licen� Approved/:'/
U PLUMBING INSPECTOR
FEES
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xture
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RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final