51139N Q
w �
I X2, .
LOT NO.
NO. MEET
APPLICATION FOR PLUMBING PERMIT
��A\ CITY ON CUPERTINO
9AR
`�` Sanitary No.DateL 1 196— Permit No��� 3 %
967
Pee $
Application is hereby made to the City of Cupertino for a permit to install plumbing
pipe artti/or fixture's listed the reverse side hereof, and agrees to install said prices
and f8i Ifixtur �n ic!�t�;�ri �sli... the provisions of the Plumbing Code of the City of
Cupertino, and all utheyt laws applicable thereto.
Use of Premises
I r,
`+ IUIVIKAl.1VK, AOL=I
Phone
State License �e
Address ��
Approved /
PLUMBING INSPECTOR 1
V
Heate
Sprinkler Valves I I II Water Sys. Fee
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final