51187/3 r -J LOT
NO. ST EEI'
APPLICATION FOR PLUMBING PERMIT
W < CITY OF CUPERTINO
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ate September 19
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i c Fee 3 3.50
° Application is hereby made QV,C1y If`7C���no alpermit toinstallplumbing
o a pipes and/or fixtures Listed on the reverse side hereof, and agrees to install said prices
i and/or fixtures in accordance with the provisions of the
Plumbing Code of the City of
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Cupertino, and all other la 1lViic0lllaa t*IPERTINO
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Use of Premises
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3 Owner J. B. Johnson Address 21383 Dexter Dr.
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By. Rayne Water Conditioning Address 243—B Moffett Blvd.
3 o CONTRACTOR, AGENT blt. View, Calif.
—Phone 9�7-4545
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02 Stare LicenseC36 5269 Approved
— U� PLUMBING INSPECTOR
FEES
Water Heate
rams
Sprinkler Valves I I II Water Sys. Fee
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
'Iain Drain
Final