51192LOT
NO. STREET
APfAA d FOR PLUMBING PERMIT
J.
T CUPERTINO
I� I�1D ntts�
Sanitary No.
U-9 Date � � 6 1968 + Permit
it No
61
�,
m�;y Fee S 5Z O d
ApplinfifiVis DFby t � ��lY1J of Cupertino for a permit to install Plumbing
pipes at s`t'ed on he 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 laNvs applicable thereto.
Use of Premises
Owner-
//
By_S�t it ly
CONIRACTOR,AGENT
Phone 24/1$'/390
State License,���
Address—,
Address
X16► IRI!! B: 8��1
Approv /
PLUMBING INSPECTOR
UNITS I FEES
ater
Area Drains I 1 II Main Drain Fee I
Sprinkler VJ,cs I I , II Water Sys. Fee
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final