100187C1` -OO U d' I i / h (/EJ -i��� LOT NO. /
NO. STREET'
APPLICATION FOR PLUMBING PERMIT
z a CITY IOP 'CUPERTINO
o DEC - ,, 1968 t'� �� sanitary No. G ofIr
3 a Uate 196_ Permit Nom, /f
ro �' Pec$ 7
Application is hereby made to'ihe'CityJof Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> I and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
wCupertino, and all other law applicable thereto.
wx
rr I /6
0a Use of Premises
oa Owner '< <�/• /7` < / J -n Address
z J
z ByTAC S ✓ T.oL-o Address
i CON AACTOA, AGENT / 4�
- m Phone 7L. �i �i "[— L'✓rtrL�
a y7L
w z r
c o State License X Approved
- U I PLUMB 7INSPECTOR
Water Heme
Sprinkler Valves I 1 II Water SYS. Fee
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final