51001.3�SOG ?-?- A &T/7. 4 ST• LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
w CITY�OP CUPERTINO
r o I " irj Sanitary No.
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3'a Date - ��' 19� , 1967 Permit No
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w LL Pee $ .34 p P
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r Application is hcrcb}' in'al3e t'o the Cit of Cupertino for permit to install Plumbing
LL w v i i .t.t L i "re Y P P as
0 a pipes and/or fixtures listed 0n the reverse side hereof, and agrees to install said prices
> r 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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LL Use of Premises � Q/
00
3 Owne✓fst-i+-K —�� Address's
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w z B /y--�-'J�c�!Address
3 CONTRACTOR, AGENT
—0 Phonc��—��%'I N
wz V'ILLIAM D.
uF State License '�?J �"r Approved
a 0
U PLUMBING INSPECTOR
FEES
Water Heate
00
ns
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final