51107.1 (3)S� I V& '"v�..i-i/ LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
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CIT CUPERTINO
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0 0 �j 1I - �1 `� Sanitary No.
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o Date nTI^ lag? 196 Permit No '5 0 7.
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n W Applicationri`4hergby made69-AciCityrof Cupertino for a permit to install plumbing
0 pipes and�r..fix ores 11st�dIon the reverse[ side hereof, and agrees to Install said prices
r and/orfixtures in accordance with the provisions of the Plumbing Code of the City of
i w Cupertino, and all other laws applicable thereto.
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LL Use of Premises
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3 Owner Address 2
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ddress
3 r CONTAACCOR, AGENT
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State License Li�O ' Approved WIL-LIjsM r1. v!trN`^rlr- /
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0 // PLUMBING INSPECTOR
UNITS I FEES
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RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough Complete..
'Iain Drain