700078I LOT NO
NO. STREET
vii FOR PLUMBING PERMIT
�IIQ'Y
OF CUPLRTINO
w 0 1 11 tl ;C7D S -
Y ¢O V / S:In 1IafV N11.
4: Rg 1966 (/o
o Date 196— Permit No �a_
3`
Cee $ if
w W ffi CIS �I�A
° 1 ati is y <e o " City of Cupertino for a permit to install plumbing
o < 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 Cupertino, and all other laws a licable thereto.
w x
� r
J4
Use of Premises
O O
> N
r 3 Owne Address �/
° A5;674?et ,
1 B Address `
° CONTRACTOR, GENT
3<
- w Phone D�
w19
a o State LicensL/7-A � / Approved
U I� PLUMBING INSPECTOR
`X/atcr Heate
nes
FEES
Sewer
Main
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final