2597LOT NO. ; � 764— 7
ET
NO. gP. LICAT'ION OR PLUMBING PERMIT
R
CIT aF CUPERTINO
r
FSB 2 8 1964 Sanitary No.
Date 'y' — 196L Permit No s
��Y. Perby Pee $
Appli I n Is ereby
ma
e 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 y�:02
Owner �-/)� )'�_ [`�-<iL /Lx-�Address
By �- �✓"�-�-r�L Address
CONTRACTOR, AGENT
Phone
State License ` s% Approved
PLUMBING INSPECTOR
o -U
Boxes
Unnats I Fixture Fee
Arca Drains Main Drain Fee 2 v7i
ater
Sprinkler Vawcs I 1 11 Water Sys. Fee I / /
RECORD OF INS-ECCTION