51167LOT NO. .-.ZZ
NO.
�AR#jL1lON FOR PLUMBING PERMIT
OF CUPF.RTINO .
Sanitary No.
Date — 9 1966 1964 Permit No� 7
Fee $ /(0 q-a—
A.f7pIrcMioIFhe���•j���¢j�tit�City of Cupertino for n permit to install plumbing
pi pCts' an dlor fixture h t t 11e"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
Owner-4-
By
wner By
Phone WCONTRACTOR, AGENT-
'
X tate License
Address,��
Addres�%a,'i
Approved
PL MBING INSPECTOR
UNITS I FEES
Boxes Boxes
Fee
rinkler Valves
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final .