2596LOT NO.
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APPLICATION JFOR PLUMBING PERMIT
Z z p Cl ��OP CUPERTINO
Y g FEP 28 1964 Sanitary No.
o'a Date `� � � � — , 196 ^T Permit No
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3 LL CITY OF CUPERT' Fee s1�
O Application is hereby made to the City of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
r- and/or fixtures in accordance with the provisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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0 o Use of Premises
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oa Owne - -��� Address
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O CONTRACTOR, AGENT
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- m Phones`-/� 3 �3
W w a State License/�F, S7 9 ' - Approv
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PLUMBING INSPECTOR
UNITS
I Water Heater
Material
Area Drains I 1 II Main Drain Fee I J '
klrr Valves
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RECORD OF INSPECTION
Underground Rough...
.Partial Rough..
�RougK nplete - -
Main Drain
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