2595LOT NO.
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AP�L`ICAT101'6F
FOR PLUMBING PERMIT
FEB 2 CI CUPERTINO
8 1964 Sanitary No.
Date --;1 - �0 196 `� Permit No
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Fee $ OCJ
Application is hereby made to the City of Cupertino for a permit t 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 'x-j�-.' -/� YJ
Owner 'Le"' ,I+ Address
By ti%-`' -� v Address
CONTRACTOR,AGENT
Phone '=�3-'
State License If (, 5 9 - Approved ' 2a
4c
PLUMBING INSPECTOR
UNITS I FH
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Area Urams I 1 II Main Drain Fee I 4 r
Sp Aler V,,i,cs I 1 11 Water Sys. Fee I / ,—
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RECORD OF INSPECTION