51167N Q
wz
4LOT NO.
No. STREET
Y
Y
Date �a 2 7
N FOR PLUMBING PERMIT
OF CUP17RTINO
Sanitary No.
Permit No
CITVnn 11 Pee $
Applicatib��s 1� to the City, of Cupertino for a permit to install plumbing
pipes and/or fixtures li�Mc ' reverse side hereof, and agrees to install said prices
and/or fixtures in accordance w the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises Dwelling
OwnePlt-7--C 8ne C0 AddressP 0O Brom,—Joo e
B, Palm Plumbing Co. Address 1234 N. HwyN. Hwy 9 -Sunnyvale
By CONTRACTOR, AGENT
Phone 245-2323
State License 186579 Approved /
{�. PLUMBING INSPECTOR
Water Heate
J-
J
ns
I, Valves
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough Complete
Main Drain
FEES