51121/0.0/ 1 r �-&11, pk LOT
NO. STREET
APPLICATION FOR PLUMBING PERMIT
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o a Date 196 Permit No
3 LL Fee $ -
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Application is hereby made 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
UNITSI FEES 1
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klrr Vmvcs
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RECORD OF INSPECTION
Underground Rough...
.Partial Rough -
Rough Complete..
Main Drain