51179 Plumbing®3/7 �0%1cc�G�l—
LOT NO.
NO. STREET
.� PPC�UC�A @N `FOR PLUMBING PERMIT
a 1 CiIY 611,1CUPERTINO
w z i
x o yIU j968 Sanitary No.
o J Date J U 196-9 Permit No
a
rl T \f 1'r C; I?EpT��!0 Pee $ 3 -
Application' is hereby ma e to he 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
/I Q
Owner Nadnri%/// Address /0.3/%
-U�
Address -W, pse�� Selo
ApprovedWILL1AM D. SENEVICI{
PLUMBING INSPECTOR
Valves
RECORD OF INSPECTION
Underground Rough...
Partial Rough..
Rough. Complete..
Main Drain
Final... - .`i