51179I
"' I` , C)! i A/7.1- LOT NO.
NO. STREET'
c FOR PLUMBING PERMIT
F CUPERTINO
1 ;
Sanitary No, r
Date 1960 Permit No �.L//?
C (� [p I (�
rl!Rt Q 9PR"4kttWRQ Pee i 3 S
ApY K tron is her a dy of Cupertino for permit to install plumbing
pipes and/or fixtures listed on th 'reverse side hereof, and agrees to install said prices
and/or fixtures in accordance wit the provisions of the Plumbing Code of the City of
Cupertino, and all other laws /applicable thereto.
Use of Premises /TSI sof -42-
Owner
-
By 1 4 Z�� Sv IL rtia /2 v
/f�TRACT�,AGENT
Phone o` ysnn—,Q//S/C�
State LicenseJ
Addresse
' / /�� 1
Address Y A (,PV -'C ea / �✓,-S.1(ale
PLUMBING INSPECTOR
I UNITS I FEES II IUNITSI FEES
Boxes
Area Drams I 1 II Main Drain Pee 1
kler
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
•Iain Drain
rinat...