51168—U`
y i G b 1 -,32t (1 % J,�
LOT NO.
A-FLIQAA N FOR PLUMBING PERMIT
TY OF CUPERTINO
/NOV 3 1965��w" Sanitary No.
2/4(/ -2 -
Dare 196_ Permit No
CITY OF CUPERTINO Fee $
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 Premises
State License /I Approved—°��-c. c�6<
/ �C
PLUMBING INSPECTOR
UNITSI FEES
Water Heate
M,
a'U
rains
r Valves
Sewer
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final .