NO PERMIT NUMBERa�TO� I ( '�"w ��L' LOT
NO. STREET
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
Sanitary No.
Date Permit No
1 9 1967 It Pee $ 0;7—� s%�
Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes iu; flares, t n the reverse side hereof, and agrees to install said prices
and/orif turesac t4
e�T� g, provisions of the Plumbing Code of the City of
Cupertino, and all other aws app is le thereto.
Ph,m ..
State LicenseG✓`�� Approved
PLUMBING INSPECTOR �/
�V
UNITS I FEES
Valves
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final .