51167.1LOT NO.' +�
NO. ST EF.I'
APPLICATION FOR PLUMBING PERMIT
az -1'1 i'-ITY P OCUPERTINO
i 0 E —�� " Sanitary No.
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oa Date _JJ10 41062 Permit No.
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Pec $ �3
'0 q�
w P;llhc�tion�irs.he�ebyr{i�a�-ly the City of Cupertino for a permit to install plumbing
0 a pipes)and�/ortbjitures(hsteLd �n ,tlicCeverse side hereof, and agrees to install said prices
r I- and/or fixtures in accordance cvttlt the provisions of the Plumbing Code of the City of
a w Cupertino, and all other lbws applicable thereto.
Use of Premises �J�/
0 0 �1y�
3 Ownerzt/G/ Address
z By�Address
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0 (.ONTRACSOR, AGENT
� Phone
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a A rcnCRjILLIMA Q, RENZVIC%$
c o State License /.�G..5�7 PP
U 1 PLUMBING INSPECTOR
UNITS I FEES
VA
aste
nnKmg rountams
nor Drains
oppers
:staurant Sinks
n Trap—
rinals
rea Drains
'ater Leaders
rmklcr Valvcs
ze
Boxes
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final