51107.1STREET
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APPLICATION FOR PLUMBING PERMIT
a CITY OF CUPERTINO
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° a Date 196L Permit No J O 7/
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i LL Fee $
r ° Application is hereby made to the City of Cupertino for a permit to install plumbing
'o < pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
< Jr) Cupertino, and all r laws applicabl thereto.
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LL Use of Premises
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< 0 State Lice O � Approved
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PLUMBING INSPECTOR v
CAI
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final