51106910140
N
LOT
NO. STREET'
xAPPLICATION FOR PLUMBING PERMIT
_I' CITY OF CUPERTINO
Sanitary \u.
Dar fMAR 1 1937 �,- 196— Permit No
s Ila-6cl
Fee $
Applieationi)is hi?*r'tSRW7 flNl i City of C rtino for a permit to install plumbing
pipedLand/or�•hiture��ht�d�lhithc reverse sid heJCaf�and agrees install said prices
and/or fixtures in accordance with the provisi ns b(�J¢ Plpwbir}g o • the City of
Cupertino, an 'r laws applicable t '� A�i.r N1
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Use joff Premise/ ^ �..� O
Own—h�i
"�r�N�t1� _1rt7y S — Address AS ANW QY2 A
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z By,1S 461 ,F --e- AddresrkLl— %L I%Zd[1P
/CONTRACTOR, AGENT
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a o State
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Licens)f ��,S�S��D APP
PLUMBING 1 SP 0 ✓
UNITSI FEES
Water Heate
aste
"foor Drains I 1 11 WATER SYSTEMA
Fee
va
I RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final