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w APP j i lONIFFOR PLUMBING PERMIT
fY CIT CUPERTINO
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o 1APR 12 1968 Sanitary No.
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3 a Date 196— Permit No.
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CITY OF CUPERTINO Pee 5 y
O Application is hereby made to the City of Cupertino for a permit to install plumbing
0 a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
>r and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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Use of Premises
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CONTRACTOR, AGENT
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u s State License Approved
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PLUMBING INSPECTOR
FEES
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xture
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
\'Iain Drain
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