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NO. STREFI'
APPLICATION FOR PLUMBING PERMIT
z aCITY OF CUPERTINO
r o �� Sanitary No.
S- ' a �'
a Uate 1961 Permit No
U
Pee Sl�-116 40
n.rl r-. -
LL W ARphcation is•hetiby,Tnade'to'the.City of Cupertino for a Permit to install Plumbing
o pipes and%or fixtures lis}ed•0nl Nie ',reverse side hereof, and agrees to install said prices
i I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all laws applic I hereto.
w z p
0 n Use of Prem ses / J)
3 O a Ad ss
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J z ' Addres Gs2 yl
3 O CONTRACT GENT
- Ph,rr,��3 -C/,/7 9
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ao State Lice'o.2` �� 7 J Approved �r
- U PLUMBING INSPECTOR J
Water Heate
rea
ler Valves
Fee
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final