2703LOT No, 6-7l
NO. STREET
G� ,C 1 �FJR PLUMBING PERMIT
OF CUPERTINO
"� I APR 17 1964 Sanitary No.
DatennA� ?/LC /2 p p 196 Permit No Q
rl � QqUP Rs,�,,. Fee$ X6.00
AppIItionQs hereby made to the 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 %165/OEi/Jr�
Owner
AUC
$yid.
Hlnii/�/f//J7G/� vG/7G
CONTRACTOR, AGENT/
Phon��9l.�963
State License /�-S
iAddress /`/DSA/,UJil/CHfy7a- .5.�
Address/50,
Approved G
PLUMBING INSPECTOR
FEES
Water Heater
Area urams
Mam llram I-ee a,0O
Water Leaders
Storm Drain Fee
Sprinkler Vanes
Water Sys. Fee /,DO
Permit Fee ,
TOTAL
TOTAL FEE
RECORD OF INSPECTION
Underground Rough..
.Partial Rough..
Rough, Complete..
Main Drain ,.�—//— 1
_