51167.1.Q
w Z
LOT NO.
NO. tt STREET
APPLICATION FOR PLUMBING PERMIT
rGKW OF CUPERTINO
Sanitary No.
Date r� ���t 196,` Permit No .f—/l6
Pee $o�lo
Ap hTt� n suer� }ujadelto,the City of Cupertino for a permit to install plumbing
pipesnd�pr Gxturc3�ltsted_on4he rwerse side hereof, and agrees to install said prices
and�or�hxtures in accordance with the provisions of the Plumbing Code of the City of
Cupertino, and all other laws applicable thereto.
Use of Premises
nDim1�;��t�
CrONI'RACTOR, AGE
Phone �yS�13.,�13
State License
ddress �
Add
Address -
Approved
PLUMBING INSPECTOR �/
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final