51174 (2)r�`-' �Y•y IIF/.�'� I� LOT NO.
?� tJ2/�J®L,ei(PP}L`hC1 GTION FOR PLUMBING PERMIT
%�Jy,;ITY OF CUPERTINO
o BSEP 16 1966 U �� sanitary No
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U1'Y -/GNU ERT n (� , 196_ Per
Application is hereby in'3d�e-lo the City of Cupertino
pipes and/or fixtures listed on the reverse side hereof,
and/or fixtures in accordance with the provisions of the
Cupertino, and all at slaws applicable thereto.
Use of Premises
Add
mit No
Fee $ Q�
for a permit to install plumbing
and agrees to install said prices
Plumbing Code of the City of
State License Approved
'�' PLUMBING INSPECTOR
UNITS
Heate
ns
xture
Water Leaders I I StormDrain Fee
�prinklcr Valvcs Water Sys. Fee Z�
RECOR6 OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
.N'Tain Drain
Final .