5118221445 I HOLLYOAK DR. LOT NO. 3,
NO. - • STAEF.I'
�RLIGATION FOR PLUMBING PERMIT
z
z ` ��� ���CITY OF CUPERTINO
z � /
i�
p S:uuCtr No.3` 16et UL iuq�G1Y J 1968 Permit -No., /*
U
w iny ,t� Pee $ -3. � U
(�
n w ! il4sph€ion iCelhere,�y�„padcittl the City of Cupertino for a permit to install plumbing
01 pipes and/or fixtures listed on the reverse side hereof, and agrees to install said prices
> r 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.
w x
r r
4 Use of Premises HOUSEHOLD
O O
3 owner GARY W. PALMER Address 21445 HOLLY OAK DB.,
Oa
ZJ
J, By SOF MASTP.R Trip.- Address P.O. Box 696
p CONTRACTOR,AGENT
3�
-Phone 379E-5050
W
z
w w
a
a o State License 214281 Approved
—04 U PLUMBING INSPECTOR
`Water Heare
I UNITS I FELS II IUNITSI FEES I
Sewer
.Sd
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final .