51187UA
• LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
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Date �- �� nni 9960q3 Permit No u
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Application is hereby made to,the City of Cupertino for a permit to install plumbing
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pipes and/or fixtures listed the revetse sidelieccof, and agrees to install said prices
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and/or fixtures in accordance withthe pro�i'sioh4 of the Plumbing Code of the City, of
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Cupertino, and all_ ther laws applicable thereto.
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Use of Premises
,a 11 110 ilta Addre�+ 3475 t^
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CONTRACTOR, AGENT
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State Lice il�d� T� App rovedW1LLIPAi D 737'NS-JICH
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PLUMBING INSPECTOR
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Hcatc
rinklcr Valves
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Alain Drain
Final