51001.222292 HAHL ST. LOT No.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
a CITY OF CUPERTINO
w
x o Sanitary No.
� LL
0 �i Date May 6, 19613 Permit No .5'—iOJ C 2
3u
iLLPees
0 Application is hereby, made to the City of Cupertino for a permit to install plumbing
01 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
a w Cupertino, and all other laws applicable thereto.
w x
LL Use of Premises HOUSEHOLD
00
> 0
� 3 Owner JACO A MARCTIS Address 99292 HART ST
0a
zJ
z By SOFTMASTER, Inc. Address P.O. Boz 696
0 CONTRACTOR, AGENT
3r
— Phone 379-5050
w z
w w
ao State License 234281 Approved
— U PLUMBING INSPECTOR
Water Hea¢
rains
0
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
-lain Drain
Final
FEES 1