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NO. STREEI'
APPL'ICA�TI,ON,FOR PLUMBING PERMIT
��,`=-CIT�Y, OF CUPERTINO
APR 11 IS68't� Sanitary No. +7
Date 196_ Permit No.
Fee$
Applicai
tion sltierebp lmade to, the 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
0 By I AD By `' '1-I Address
3 o CONTRACTOR, AGENT
- am Phone
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a o tate License. Approved
U4 ? PLUMBING INSPECTOR
UNITSI FEES I
Water Neate
Sewer
rains
kler Valves
Fee
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
�4ain Drain /
Final �--