262816� . i .LOT NO. /
TAE
I OR PLUMBING PERMIT �
MAR 4' 1964 OF CUPERTINO
Sanitary No.
Date 196 Permit No� C.N
I OO
``� Fet$7
Application is hereby made to the City of Cupertino fora penstall plumbing r,
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
Owner4'g' -10-1C1C2 rl Address
By Z— ,1.1s �c i ./'
CONTRACTOR, AGENT
Phone o�� S' o� 3 -3
State License �� s �9In
E4
Approvedz&)"'GSC..
PLUMBING INSPECTOR
nkler Vo
UNITS I FEES
Cel➢
dTi
m�