51167LOT NO.
NO, STREET
APPLICATION FOR PLUMBING PERMIT
d CITY OF CUPERTINO
x o AN Sanitary No.
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3 < Date r�, I Permit No
U
NOV I Q67GG_Pee $
o Application is hereby made to the City of Cupertino for a permit to install plumbing
o pipes and/or fixtures listej� {� side hereof, and agrees to install said rices
i m and/or fill rTs n {fie, rd�9600 t[911isions of the Plumbing Code of the City of
a w Cupertino,kdntd�ll of er aws applicable thereto.
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LL Use of Premises
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o< Owner Y�%ir FMC5,51�.! A%7i Addryess
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J By CO✓IGWtC� Address
O NTRA OR, AGENT
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— W Phones
ao State License_ Approved
—0 f ./- PLUMBING INSPECTOR
Sewer Boxes
nes
Area Urams I 1 II Main Uram Pee I
Sprinkler Vnlvcs I 1 II .Water Sys. Fee
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough Complete -
Main Drain
Final...