51181 (4)>C oZ 148 S I Hoc LOT NO.
NO. STREET
APPLICATION FOR PLUMBING PERMIT
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CITY OF CUPERTINO
rp Sanitary No.
0 < Date S 9 Permit No &7 11! l
SEP 9 1968 Fee$. a
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� Application is hereby made to the City of Cupertino for a permit to install plumbing
o pipes anj�/�c�c �7zty'%{{yy�- li�/-� �I}- e side hereof, and agrees to install said rices
I and/or luldrds irco�y�Frovisions of the Plumbing Code of the City of
a w Cupertino, and all other laws applicable thereto.
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w Use of Premises
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3 Owne Address: 495;;'Ve"I Q1X- qL
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3 0 CONTRACTOR, AGENT
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< o State License Approved/-�
4 �PLUN GING INSPECTOR
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
'Iain Drain
Final /jS — %