51084/ V - i • V r - I LOT NO.
NO. STREET
APPLICATI FOR PLUMBING PERMIT
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� 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
i a and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
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0 / 6 '/ // PLUMBING INSPECTOR
I UNITS I FEES II IUNITSI FEES
Water Heate
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Sprlvller Valves I 1 II Water Sys. Fee I/ �_
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
A -lain Drain