511671113/ I /�/Wyer('Es IJ/ LOT NO. L�L
No. STIUEE9'
APPLICATION FOR PLUMBING PERMIT
CITY OF CUPERTINO
Sanitary No
D,, r'nn 1962 Permit No.
.1' /ice 7
// • Pee 5 0'O
A IlcjWNisjb4reQ&7adel City of Cupertino for a permit to install plumbing
pipes and/or fixtures listed on he 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
C,@jT,yo, Of alCUPERnNO'icable thereto.
Use of Premises
Owner lgoheefi L. #0"X6—
J z By / 5 eJ(a/ gtrr5F.y -
3 O 0.CS 1.T RI/j / R63 NT
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- Phone
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a a
c o State License
Address /// 3 7 Afl,3 blerKe-s 0v
Address
Approved
PLUMBING INSPECTOR
Ins
ns
UNITS I FEES
ze
Main
Fee
Sprinller Valves I 1 11 Water Sys. Fee
RECORD OF INSPECTION
Underground Rough
Partial Rough
Rough. Complete
Main Drain
Final