51128'Z?co5�-_l
NO. STREET'
LOT
APPLICATION FOR PLUMBING PERMIT
/r?D j j wOP CUPERTINO
�Ili
Sanitary iN o.
Date
DateO �'Permit No
Pee $
App�s\p ire6�j�crt(}ti�cl ity of Cupertino for a permit to install plumbing
pipes o fi es d t I}'!, rse 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
Owner(nn . ' Z'e�ft Z
By_fL,S�LE�l.4% CA laZ-ef_
CONTRACTOR, AGENT
Phone ,'l 3D,37
State License
Address
Approved `'�
6//PLUMBING INSPECT R V
Water Heate
Sewer Boxes
FEES
"lour Urains WATER SYSTEM ---I
Hoppers Size
nklcr Valvcs
Fee
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final