51167LOT NO, 15
No. a 6'-fRc-F�
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APPL-IC�4T1011 FOR PLUMBING PERMIT
�����TY OP CUPERTINO
xo UG 31. 1966 �x:CJ Sanitary No.
0 Date �� 196Permit No
3 E CITY OF CUPERTINO Pee 5
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� Application is hereby made to the Cit}' of Cupertino for a permit to install plumbing
o < 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
a w Cupertino, and all other laws applicable thereto.
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w Use of Premises.1<<l-/-A
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oa Owneryd�(,�,�q —�i1�t�'/, �!• Addresrf� �.
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F CONTRACTOR, AGENT
- 0 Phoneme XJ a3a3
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a o State License , Approved
— U 4// PL MBING INSPECTOR
I
FEES
Water Heate
Sewer
Material
Icr Valvcs
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final