51167,2.C5i'3 I , J,4. LOT NO.
NO. STREET'
06N tFOR PLUMBING PERMIT
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CUPERTINO
F o `� IMAY `2 Sanitary iN'o.
M 7 1966 Po J Date Permit No
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O Application is hereby m d e i y of Cupertino for a permit to install plumbing
o a pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> 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.
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Use of Premises
Owner
Dita-Crane Co.
By Palm Plumbing Co.
CONTRACTOR,AGENT
Phone245-2323
State License 3865799
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Address P. 0. Box 509 -San Jose
Address-12-�4 N. Hwy 9'aumuyale
Approved
PLUMBING INSPECTOR
UNITS I FEES
Wv/ t Hcatc
ns
nkler Val,cs
Fee
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final .