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APPLICATION
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LOT NO.
FOR PLUMBING PERMIT
OF CUPERTINO
Sanitary No.
Date p , 196— Permit No �// 6 ,7
C"TY Ci NPERT ti1�v Pee$ ��
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
By ,Z;) ejrj�/
TRACTOR, AGENT
Phone S<s 3 Z 3
State License r,-771
Address
Address
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Approved G r/
PLUMBING INSPECTOR
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Fee
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RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final
FEES