100043N Q
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C,4 1L. A N LOT NO.
0 STR F.i' 1 D t FOR PLUMBING PERMIT
JUN 25 1965 I OF CUPF.RTINO
9 !moi Sanitary No.
Date w 3 — ��96 �-+ Permit NoCITY ul-
Pee $
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 provision of the Plumbing Code of the City of
Cupertino, and all er ;ws applicable t
Q
Use of Premises
n
Phone-'I�ff —'U/ gy%
vS/tate Licen � $4.30 A
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PLUMBING INSPECTOR
Water Heate
ng
ns
ler Va
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final