51167/MqY _,419
66
LOT
:OR PLUMBING PERMIT
OF CUPERTINO
_ Sanitary No.
�I
D196( Permit No./f-qU��
P T N(� I Pee $SIO
Application is hereby mad /t is City of Cupertino for a permit to install plumbing
pipes and/or fixtures 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
Owner —��- Address ;fli. 4�T `rte
Address
State License /�/'3-79 Approve
UMBING INSPECTOR
Water Heate
xture
Boxes
Fee
r vd,cs
RECORD'OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
%lain Drain
Fina
i0-0