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APPLICATION FOR PLUMBING PERMIT
u, ' CITY OF CUPERTINO
I a _ Sanitary No.
3 Date �C Permit No , 1407.r
W W NOV 13 190% Fee S S00
2 O
� Application is hereby made to the City of Cupertino for a permit to install plumbing
o pipes and or 6 t res s d he reverse side hereof; and agrees to install said rices
and/�rc�iirei a i, rovisions of the Plumbing Code of the City of
i w Cupertino, an all of er laws appo ii able thereto.
w 2
r
0 w Use of Premises ( e K£.25 -
3 Owner�a")''W JtJ/ l 1y�A' Address Dc' -Pa
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J o B �iso..o..-�'.- t.2a Address
a� �-� i%i+t'
r CONTRACTO , AGENT
- W Phone
oState License / a� G • Approved
PLUMBING INSPECTOR
UNITS I FEES
ns
Main Drain Fee
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough, Complete..
Main Drain
Final---