51167.3/�` '' Lot No.
E DEC 16 -1968
APPLICATION
OF CUPERTINO PERMIT
_ Sanitary No. GO Fj41 QF
E Dale .�' `—n i% •�, 196�� Permit No..S//(. % 3
,
Y
° Fee $3. 4)7-0
3
Application is 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. i
0
3 =
v Use of Premises
° Owner / --. A resa��
9
By ��� /��y/�{/�/,// /iJ Address
//Contractor, Agent
° Phone
ro 3
ro /el/c%9 Approved WILLIAM D. GENcVICF
State License
Plumbing Inspector
Units
Dish
Water Softener
Size
DRAINAGE
Comb.Sink & Tray I 1 II To Curb I I
Size
Water Svs. Fee
Total Fee