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'NO.�\ STREI
A PLIC
to EC 14 1967
TION
� CITY
1
LOT
FOR PLUMBING PERMIT
OF CUPERTINO
Sanitary No.
1/'
Date— - 1 _r {� (� 196 --:-'Permit No. J
'J' ( � LIf (JIFLU INN Fee $ 14/, 1
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 Premises
Owner /l�tr:GAddress
By, Address
CONTRACTOR, AGENT
Phone.�5%S—o73o�
'ILState LicenseG s
P
WILLIAM D. G MC'11CH
PLUMBING INSPECTOR V"
UNITS
Water
Boxes
3 C%
Sprinkler volvcs I 1 II Water ays. ree 1 /s7/
RECORD OF INSPECTION