51177.1I No.
p.
LOT
STREE.I'
APPLICATION FOR PLUMBING PERMIT
W a' CITY OF CUPERTINO
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*M" SOF meq Sanitary iV o.
I LL /r o
o a DI it 196— Permit No 7 7 /
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971 Fee 5
'0 ApliAioryisf6�creby made to the City of Cupertino for a permit to install plumbing
`o a pipes and/or fix es listed on the reverse side hereof, and agrees to install said prices
>1- and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable
%thereto.
0 n Use of Premises
00
3 Own%/eprr g -p— Address
zz By/�"l"" 5T- W Address
O CONTRACTOR, AGENT
Phone �G�'�— 3/id0 ~
0 o State License��yyy0 Approved
PLUMBING INSPECTOR
UNITS I FEES
ns
Fee
Sprinklcr Valves I 1 11 Water Sys. Fee I / �-7)
RECORD OF INSPECTION
Main Drain