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NO, 'STR V _
APPLI/CATION FOR PLUMBING PERMIT
CITY OF CUPEiRTINO
I� D
V
Sanitary NO.
Dat iY 'Th196 Permit No
1 AY 9 1967 Pee -
Application is hereby made to the City, of Cupertino for a permit to install plumbing
PINT d�fr�q-fix�,y{tes listed on the reverse side hereof, and agrees to install said prices
and' Orfix uses (110. 774NAh the provisions of the Plumbing Code of the City of
Cupertino, and
Use
Approved
PLUMBING INSPECTOR �j
Watet Heate
Valves
RECORD OF INSPECTION
FEES