2591/U /�j�' _ LOT Nd. /
4= RV > FOR PLUMBING PERMIT •
" ` FEB 2 8 1964 or CUkRTINO
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r 0 // Sanitary No.
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Da �I^196Z Permit No.
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
0 < pipes and/or fixtures. listed on the reverse side hereof, and agrees to install said prices
r 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.
a Use'of Premises
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O CONTRACTOR, AGENT
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rc u State License�� S Approved
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PLUMBING INSPECTOR
FEES II IUNITSI FEES I
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Store
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Boxes
Sprinkler Varves II Water Sys. Fee I y�
Permit Fee /�
RECORD OF