10001610645 F John Fav
LOT
- NO. STREET
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
Sanitary No. !r L- (/
Date December 1 , 196 4 Permit No/(f 0,o r;
Fee $
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.
Use of Premises
Ward Crump & Assoc.
By Crowley Company.
CONTRACTOR, AGENT
Phone YO 7-55 B
State License 166998
PO Box 634 Cupertino
Address 855 Jackson Mtn View
Approved
40, PLUMBING INSPECTOR
Water Heate
I UNITS I FEES II .. IUNITSI FEES
Boxes
Sprinkler valves I 1 II Water Sys., Fee
RECORD OF INSPECTION /
Partial Rough..
Rough, Complete..
Main Drain
Final._