NO PERMIT NUMBERf//Vn'1-C- LOT NO. 9/
NO. STREET
_ APPLICATION FOR PLUMBING PERMIT
11 E/"', CI I �OF CUPERTINO
Sanitary No.
Date �-� ;�C� 1967 196� Permit No
Fee $ �� •.�O
�'-7aii isT 171 nrr'lrf S I(^.
Application 'Is hereby made,to thelGty of Cupertino for a permit to install plumbing
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
Cupertino, and all other laws applicable thereto.
Use of Premises
1 ��''JWWw 7�����
W. _ //
C• •'
Phone .2 92 -Po72
- tate License r
ApproWILL1AM D. W=NMVEIN
PLUMBING INSPECTOR k
I UNITS I FEES II IUNITSI FEES I
Boxes
Its
Urinals Fixture Fee' IZ6 „r0
area Drains Mairy Drain Fee ,� , pp
r Valves
I 1 II Permit Fee 1 —2.00
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
\lain Drain
Final...