2343wky LOT NO.Of
STREET ,
APPLICATION .FOR PLUMBING PERMIT
CITY OP CUPERTINO
AUG 13 1963 .: Sanitary No.
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0 < Date '� � 196— Permit No 9 3XS
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TY OF CIJPER'E! Pee $ � � �
Application is hereby made to the City of Cupertino for a permit to install Plumbing
'oa 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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Use of Premises I FA"
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oa Owner^^Y \ I r�� 4 Addres� r'�N l 743 C i 5 C 3
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State License 92,a Approved
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PLUMBING INSPECTOR
MWater Heater
ater
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rain
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fixture
Fee
RECORD OF INSPECTION
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FEES