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` LOT NO.
NO. MEET
APPLICATION FOR PLUMBING PERMIT
ATY OF CUPERTINO
�ii, AR ] 6 1967 t� S'""ary No.
Date 196_ Permit No
i� T\i n—-i"'OFQ�IgIn . Fee $
6-7
Apphcition,is;hc,, made t 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
Owner
B' N
O CON RACT R, A RNT
30 9l
W z Phone
a o State License. ) 3 O y,
FEES
Boxes
Fee
V a Ivcs
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete '
Main Drain
Final
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