NO PERMIT NUMBERasp-n`-cs— 64-& -P� LOT NO. V
NO. STREET
N < �AP C_A
wONj FOR PLUMBING PERMIT
z �J CITYOF CUPERTINO
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0 li_ )Ec GP, 1967 -IJ Sanitary No.
0 a Date / �n pT196,7 Permit No
= o . f3� 1 ��� 1� 1'10 Fee S
Applicationus hereby made to the City of 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
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.
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Use of Premises
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3 Owner
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O CONTRACTOR, AGENT
m Phone ��jC-Y t ?e2 % %
o State License���`l —U
Address
Approved WILLIAM. D. 9E%' -r VICFL
PLUMBING INSPECTOR T fj
FEES I
01
Sprinkler Valves I 1 II Water Sys. Fee -L/ S -o
RECORD OF INSPECTION
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