51192 (2)/0
/ e-0 I w3 "' * LOT NO.
NO. STREP.,'
APPL_IG'ATCTY
FOR PLUMBING PERMIT
0¢ :UPP.RTINO
(SUN 6 1968 q S:mitary �'u.
Dat I9 Pc
Applicafi'p�n Y hPe y m URERTWal- Cupertino
pipes and/or fixtures listed on the reverse side hereof,
and/or fixtures in accordance with the provisions of th
Cupertino, and all other Ia�3s applicable thereto.
Per
Use of Premises
Owner�V
CONTRACTOR, AGENT
Phone 7 4/,E Z %f6
State License z�5 , n S M
No, x//�,_2.
Pee $
for a permit to install plumbing
and agrees to install said prices
e Plumbing Code of the City of
Address C%�7��
WILLMM ®. btNEVICH
Approved
PLUMBING INSPECTOR
Heate
rea
RECORD OF INSPECTION