51181"`/Y�Z G 4o Lt; LOT NO.
NO. STREET
APPL CANON FOR t-LUMBING PERMIT
.j �6T,[I VINO
j� Sanitary NO.
Date `�UN 1 9 26V �� Permit No S//cf/
. Pee $ -3Application is h.er�by�1marterto thneIarpTCupet.no
for a permit to install plumbing
pipes and/or fixtures listed on the 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.
I / / I — I—
Use of Premises If 4? S.—q(Qsr C
Address-�Y C!/Pi'CP-,��`y„ S�V/Q
PLOMBING INSPECTOR
its
Sprinkler Valves I 1 II Water Sys. Fee
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain