51167 (2)N Q
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NO. ` STREET'
P LICATION
CITY
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m -t iia..
LOT NO. -Z
FOR PLUMBING PERMIT
OF CUPERTINO
Sanitary No.
Permit No, %
Pee $ /(0 0 0
C�T^�ipo de to the City of Cupertino for a permit to install plumbing
pipes ar1t1/orcc�s cI r� 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
Own '�i1� i/ ��r Addres�/����/��
B • Address �i�'�r�uiQeJ
CONTRACTOR, AGENT
Phone
/1
State Licence i- Approved
PL' IBING INSPECTOR i /
FEES I
Heate
ns
rinklcr V.
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
'Iain Drain
Final