51073,22 _W Q 191%. 1%. . LOT NO.
NO. STIIEEI'
FOR PLUMBING PERMIT
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F CUPERTINO
(FE911966Sanitary No. Sly
Date � TY (�C (�IIpCDT p Permit No �
�illr A `tfr E6OPERtbINai Pee S
Ap t a on her d}' of Cupertino for 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 gNtesxlaws applicable t)�ereto.
Use of Premises
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PLUMBING INSPECTOR
UNITS
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Fee
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain