NO PERMIT NUMBER (6)LOT NO.
NO. STREET
N ® �dAPCATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
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Sanitary No.
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O j ate I: 196 Permit No
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p io,(lpsl q�j7 }�,fy�to the Cit}' of Cupertino for a permit to install plumbing
`o a pipes an /O'q'i rFslliSt��Vd the reverse side hereof, and agrees to install said prices
> and/or fixtures in accordance with the provisions of the Plumbing Code of the Cit}, ofy
a w Cupertino, and all other laws applicable thereto.
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0 Use of Premises(/,if2CG.y tC.1tr�Gd� "✓�� S -yFJW .
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3 Owner e Address
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COMAA 3 OR, AGENT 736- /�f
— `m Phone
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aState License ASi�� Approved
7 y/
PLUMBING INSPECTOR V
302
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Hain Drain
Final