51192.1 o No. Street Lot No. O
/0/a M 'C- 1-1-0 �L wo�L> f'Atiro
v APPLICATION FOR PLUMBING PERMIT a
E CITY OF CUPERTINO c- , R +
ti �-% 'Samtary-No. . ` p
" Z , 196 �� n 1966 Permit No.�//4 1. Z. A
Dale "�'l�t _
Fee$3 S L c
3 T
z Application is hereby made to the City of Cupertino for a permit.to install plumbing pipes b
and/or fixtures listed on the reverse side hereof,and agrees to install said prices and/or fixtures
° A in accordance with[ ons of the Plumbing Code of the City of Cupertino,and all other
'9"E laws applicable thetef o.
° t �
dw Sze a s7- 61e,61e,n mises Use of Pre ��"
o V
° Owner T). l.>O�M ff/✓ Address17 A
d
By��� SO GTL oTC� Address
iy3s
3 Contractor,/Agent
01 ° Phone�/— %��gl
State License 736 Approved
Plumbing Inspector
a � a
a a � W
W
W c�
J80
FFF o W U F ^%
in � ink FF Sin ii � in3 € F
m
a d
W W
m
z �
� F `v O v a F c rn C `ij 5 ° a`� � •-7 °: u E
u. 33mrn ..tYp3333mU ° °` u. xaN ,7a3va, j � � o
F