51158 (9)'S". LOT NO.
ND.. ��-STI EET
'APPLIC'ATION f,OR PLUMBING PERMIT
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1\/ CITY, OF CUPF.RTINO
OV
V -4 1966!.
x o t _ Sanitary No.
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o Date 196— Permit No
I3 sv LL G. I V OF CU�ERT'�'�; Pees
o Application is hereby made to the City of Cupertino for a permit to install plumbing
0 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 w Cupertino, and all other laws a plicable thereto.
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Use of Premises
00
oa Ownee�r– ®[w 6l� e T Address, -5�/�- "e-e-A ez,a/
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z By/C�iV,&- l�C/�� At //1' iii S Address 3�p• /•MA�II�%/�1�C e
O —�- CONTRACTOR, AGENT lgw�lr/eo//7 -exv;X
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Phone 7/// �59�
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ao State License 24Z0MLK' Approved
- U PLUMBING INSPECTOR
UNITS I FEES 11 1UNITS I FEES
Main
Fee
RECORD OF INSPECTION
Underground Rough
Partial Rnugh
Rough. Complete
Main Drain
Final