51161LOT NO.
NO. STREET
FSEP`eAP_P,L , ATIOINFOR PLUMBING PERMIT
IIC ITY OF CUPERTfNO
1. 196
Date �-S� Permit No. �ll ('
CITY OF CUPERTINO Fee $ "�q0 0,0
Application is hereby made to the City of Cupertino 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.
Use of
1 '7339
Valves
Fee
RECORD OF INSPECTION
EN