51181/o7y6 �i> t�� ray i�. �� LOT NO. J
NO. STREET'
APPLICATION FOR PLUMBING PERMIT
.z E �� . I S C?i•Ttfto,r CUPERTINOo Sanitary \u.
3 Date tl I nQ Permit No,.i/�k/
w LL v Pee S < dy
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4 w Applicat n�js hgr by ��ada�e�l�e�C4of Cupertino for a permit to, install plumbing 'I
01 pipes and�o4 xt�ire bs ed�on the revers side hereof, and agrees to install said prices
> and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other Taws applicable thereto.
w i i
Use of Premises -A --t� S.
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3 Owner. 14)alCle'!'L Address 7376
C� m` �'•'n
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z By Address
O CONTRACTOR, AGENT
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- 0 Phone ,n2 O Gyyo
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atate License Approved
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YU PLUMBING INSPECTOR
FEES
Water Heate
nes
ns
Valves
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
\•Iain Drain
Final