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. S11ERT
N NoIFINOV
P CAST OFI §OR PLUMBING PERMIT
a SCI JOP CUPERTINO
z 0 !I'� Sanitary No.
o j OST 2T3 t,::.
3 U- Date /n� �/ 1� 19(� Permit No
LL L: 1 OF I�UPFRR n�. Fee
0 Application is hereby made o the City of Cupertino for a permit to Install plumbing
o < pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r 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.
RESIDENCE
Use of Premises
00
3 Owner Address
0a
ZJ
J z By G/Z //L6` eo Address
J 0
3 r- CONTRA OR, AGENT
— 0 Phone V0 7--5-!5-7-V
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E State License Approved
a 0
PLUMBING INSPECTOR
0 Water Heater
M
FEES
unnals Pasture Fee
Arca Drains Main Drain 1'ee 2,00
Sprinkler Valves I 1 II Water Sys. Fee I /,00
RECORD OF INSPECTIO�.j.
Underground Rough../ --0-4/
Drain