51167Ile) -2O 5"1 /4— LOT NO.
NO. STREET
APPLICATION FOR PLUMBING
T Of CUPERTINO
Sanitary No
Date Permit I`
PERMIT
Fee $ 3. TV
Application is hereby made to the City of Cupertino for a permit to install plumbing
pipes an �Yixt liq �{�� �q a side hereof, and agrees to install said rices
and/or x ores in�a cor2ftc'wSth' t�N�'rovisions of the Plumbing Code o6 the City of
Cupertino, and all othe5--1S1L-s applicabl` thereto.
Use of Premises
State Licensr• of -- i-��5 n— Approved /
r / PLUMBING INSPECCOR '/
FEES
Sprinkler Valves I I _11 Water Sys. Fee I ( ()-n
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
' Final...