100189zo
S� � LOT NO.
NO. STREET
APPL'ICATJON FOP,,PLUMBING PERMIT
tCJ PERTINO
Sanitary No. /o/ ss
Date 196_ Permit No /G 7
.! ERTIIVO Pee $._
Applicatiorril' •Thereby+n ad o the City of Cupertino for a permit to install Plumbing
pipes and/or 'ixtures listed on the reverse 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.
Use of Premises
CONTRACTOR, AGENT
State License2sOlgo .
Address
Address
Approved (N
PLUMBING INSPECTOI
Water Heate
vatones
rea
ler
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Nlain Drain
Final