51193 (2)LOT NO.
NO. � STA F. F.I'
APPLICATION FOR PLUMBING PERMIT
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s o � Sanitary No. �p
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3 U A o Fees
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Application is hereby made to the City, of Cupertino for a permit to install plumbing
`o a piprsl �T(�/or� to I i reverse side hereof, and agrees to install said prices
> anc{� u x/tox o w�'iEH'the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable: thereto.
a Use of Premises - i � t �/'-"•-�'F -��
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��cCC-c-c.c�.✓%�=.�_...�-.. •. AddressJl �� _f''/le<.
J o CONTRACTOR, AGEN
3w Phone
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a o�5tate License �v �j`� Approved
U PLUMBING INS P oB `/
Water Heate
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1,3-u
/Y0
UNITS
urinals Fixture Fee
Area Drains I �� Main Drain Fee
kler Valves
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final