51167.1NO. STREEI'
LOT NO. Q7
® AAN FOR PLUMBING PERMIT
AM LF CUPERTINO
Sanitary No. -OS�
ry _
Date Permit No ,5 // G i, /
Eee$o7—G S�
AppfQ if)Frel C hg qty of Cupertino for a permit to install plumbing
pipes am r fixrdres fft� F�c?lrev rsc 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 Premisesty«�
Owner ��artl C�D Address
By Sv�ACTOA,AGENT Address /
Phone -?-> T- �3sj
State License
Approved
PLUMBING INSPECTOR
V
rea
klrr Valvcs
13
RECORD OF INSPECTION
Main Drain I
Final