51167.1�Y /�G� I ✓/l�ra�C�I�6[rG-z= LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
'z a CITY OF CUPERTINO 3 %o Z.
o' Date - —`, 19(><.� Permit No .S //y: 7, /
3a p P
tAUU 1.1 1967 _., Fee lr(:S-573
o Application is hereby made to the City of Cupertino for a permit to install plumbing
o pipes and/or fixtures listed on the reverse side hereof, and agrees to install said rices
I and/or�fl$fulys in acc�f%!1rCi�wtih the Provisions of the Plumbing Code of the City of
a w Cupertino, rand alltothe'r`luws appli Me thereto.
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0 <ll Use of Premises . < s .y
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o Owner?✓ �ilysG�.(� Address q
z I3yLiJ.r %�///�.���A Address
CO54TRACTOR, AGENT
3�
—0 Phone
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o
State License -�� Approved
U F PLUMBING INSPECTOR (/
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough Complete
Main Drain
Final