51175.1e2 �. 'Y G Art i e &AA V % LOT NO. / CL
O. STREET
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APPLICATION FOR PLUMBING PERMIT
t CITY OF CUPERTINO
GA f -1
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Sanitary Nn.
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DaPermit No
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Fee $
Application is hereby made to the City of Cupertino for a permit to install plumbing
pirp'sj cl/Mrlfixtiir2q*lipgT;ltne reverse side hereof, and agrees to install said prires
and/or fixtures m a turd c with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
Owner Address
L
CONTRACTOR, AGENT
Phone 3 ZC/—
State License 3 1/0 41e 7
V
FEES
ns
Sewer Boxes
xture
sprinkler Valves I I II Water Sys. Fee
O
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final