51145 (4)NO. STREET
W ``�APPL'IGATION
-i ` i --�'L' �� ��i CITY
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1011
FOR PLUMBING PERMIT
OF CUPERTINO
Sanitary \'o.
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o Date 196Ae, Permit No
3¢
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oCI I,AppFatior!is'PERTm�ald? to the City of Cupertino for a permit to install plumbing
o a 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
a w Cupertino, and all other laws applicable thereto.
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.. Use of Premises __�9tr C7 Orin ,F�Prs
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Owner I)Pi7 tL)Yr-1/evls ems. Address-? 2-t
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State License
Approved
PLUMBING INSPECTOR
FEES I
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Sprinkler Valves I I -) II Water Sys. Fee
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RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
\Iain Drain
Final