2599LOT NO.
NO. � STR i
® {'PPLIC II
I IOR'M
MBING PERMIT
OpCUPERTINO
FEB 2 81964 lU>� Sanitary No. _ _
Date �" — 196 Permit No. p
CITY OF CUPERT;^'^ PeesLL�
Application is hereby made to the City 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
CONTRACTOR, AGENT
State License w 6 'e —?
i
Approved
ems
PLUMBING INSPECTOR
UNITS I FEES
ze
Area Urams I 1 II Main Drain Fee I _2 e'
Sprinkler Vaivcs I 1 11 Water Sys. Fee I i 4,—v
RECORD OF