51167LOT
NO. STItEF,I'
APPLICATI0>1FMUkMNG PERMIT
c, Sanitary
bate / — c� 7— �6 196$er JAS .5—i/
Fee $�� -
Application is hereby made�t'o� Ch C �oC ppf-n �a( ermit to install plumbing
i es and/or fixtures listed on the reverse sid'e%er
p F / etl� nd�ta�rees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all laws applica reto.
C � u
State Li����`� Approved
PLUMBING INSPECTOR
'Vatcr Heate
ns
nkler Valvcs
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RECORD OF INSPECTION
Fee
UNITSI FEES