51154 (2)[�D 9 I " LOT NO,
NO. STR2P.
AP . I _ ION FOR PLUMBING PERMIT
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OF CUPERTINO
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x o tl Sanitary No.
o a Date OCT 1 96_ Permit No
3 LL Pee 5
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AQ' ITNfio hbfptoOpt City of Cupertino for a permit to install plumbing
o a pipes and%or�ktur�4i�tc Opt"
Reverse side hereof, and agrees to install said prices
>I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applic, ble thereto.
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Use of Premises
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3 Owner Addres
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O q CONTRRACTOR, AGENT
3 w Phone—3-2 % (5-c
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a o State License !/ ds % �U Approved
U PLUMBING INSPECTOR �/
Water Heate
Sewer Boxes
UNITSI FEES I
Ilcwr Drains I 1 II WATER SYSTEM2EEV--U
Sprinkler Valves I 1 II Water Sys. Fee I /. 00
RECORD' OF INSPECTION '
Underground Rough
Partial Rough
Rough. Complete
Final