51167NO. I STREET (,
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-APPLICATION
CITY
(DEC 11 1967
LOT NO. /
FOR PLUMBING PERMIT
OF CUPERTINO
Sanitary No.
Date 1962 Permit No Y-// IL %
CITOF CUPERTINO Fee S 0Z -4,J-6
Application is hereby, made 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 PPrremi/ses/nom
Ownerr_7
By �G�.,
<< .rte
CO TRACCOA, AGENT/
Phone
State License
Address
1,131
Address
Approved
WILLIAM D. GENEZVICH
PLUMBING INSPECTOR
X
Heate
Sprinkler Valves I I II Water SYS. Fee lira
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete -
Main Drain
Final...