51167It -No
No. MEET
A FOR PLUMBING PERMIT
f I CUPERTINO
Sanitary No.
J _
Date ���AR r � 8 Permit No j //( %
Fee $ 3-5-6
Appl t�is(f� eb t I V of Cupertino for a permit to install plumbing
pipes acid r hxt�Qr s I o t e rse side hereof, and agrees to install said prices
and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
n
Use of Premises
State
ress
PLUMBING INSPE(7oit
/111
UNITS I FEES
rea
Sprinkler Valves I 1 11 Water Sys. Fee •c)D
RECORD OF INSPECTION
_Underground Rough...
Partial Rough..
Rough Complete..
Main Drain
Final...