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10164 I Randy Lane LOT
NO. STREET'
PLUMBING PERMIT
CUPE.RTINO
Sanitary No.
Permit No .-// ia.olr
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o a° rd{jLiF'ptiy�Les 143JIf W\ F�1`.1� City of Cupertino for a permit to install plumbing
pi l /o xtu s i 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
a w Cupertino, and all other laws applicable thereto.
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Use of Premises residence
00
3 Owne,H• C. Ganske Address 10164 Randy Lane
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By Culligan Address380 East Evelyn
°CONTRACTOR, AGENT Sunnyvale, Calif. .
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—0 Phone 736-P000
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ao State License#241785
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Approved
PLUMBING INSPECTOR
Water Heater
To Curb
WATER
Water Sys. Fee
Total
Fees